Point-to-point sub-orbital space tourism: Some initial considerations

NASA Astrophysics Data System (ADS)

Webber, Derek

2010-06-01

Several public statements have been made about the possible, or even likely, extension of initial sub-orbital space tourism operations to encompass point-to-point travel. It is the purpose of this paper to explore some of the basic considerations for such a plan, in order to understand both its merits and its problems. The paper will discuss a range of perspectives, from basic physics to market segmentation, from ground segment logistics to spacecraft design considerations. It is important that these initial considerations are grasped before more detailed planning and design takes place.

Cannabis for Chronic Pain: Challenges and Considerations.

PubMed

Romero-Sandoval, E Alfonso; Fincham, Jack E; Kolano, Ashley L; Sharpe, Brandi N; Alvarado-Vázquez, P Abigail

2018-06-01

The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented. © 2018 Pharmacotherapy Publications, Inc.

The controversy about a possible relationship between mobile phone use and cancer.

PubMed

Kundi, Michael

2010-08-01

Over the last decade, mobile phone use increased to almost 100% prevalence in many countries. Evidence for potential health hazards accumulated in parallel by epidemiologic investigations has raised controversies about the appropriate interpretation and the degree of bias and confounding responsible for reduced or increased risk estimates. Overall, 33 epidemiologic studies were identified in the peer-reviewed literature, mostly (25) about brain tumors. Methodologic considerations revealed that three important conditions for epidemiologic studies to detect an increased risk are not met:no evidence-based exposure metric is available; the observed duration of mobile phone use is generally still too low; no evidence-based selection of end points among the grossly different types of neoplasias is possible because of lack of etiologic hypotheses. The overall evidence speaks in favor of an increased risk, but its magnitude cannot be assessed at present because of insufficient information on long-term use.

Specimen Examinations for Merchant Marine Engineer Licenses (2nd and 3rd Assistant).

DTIC Science & Technology

1978-02-01

blue color with evidence of overheating have probably been operated with A. excessive speed. B. improper warm - up . C. extreme misalignment. D. inadequate...the boiler has been blown down or chemicals added. C. when the boiler has been refilled with make- up feed. D. from the highest point in the feed system...An important consideration in the prevention of carry-over in a marine boiler is to A. properly treat the boiler water with hydrazine, B. control the

Willingness of the Local Health Department Workforce to Respond to Infectious Disease Events: Empirical, Ethical, and Legal Considerations

PubMed Central

Rutkow, Lainie; Barnett, Daniel J.

2014-01-01

According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies. PMID:24963648

20 CFR 322.4 - Consideration of evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Consideration of evidence. 322.4 Section 322.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.4 Consideration of evidence. (a) Initial proof. A claimant's certification...

20 CFR 322.4 - Consideration of evidence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Consideration of evidence. 322.4 Section 322.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.4 Consideration of evidence. (a) Initial proof. A claimant's certification...

20 CFR 322.4 - Consideration of evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Consideration of evidence. 322.4 Section 322.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.4 Consideration of evidence. (a) Initial proof. A claimant's certification...

A History of Nanobubbles.

PubMed

Alheshibri, Muidh; Qian, Jing; Jehannin, Marie; Craig, Vincent S J

2016-11-01

We follow the history of nanobubbles from the earliest experiments pointing to their existence to recent years. We cover the effect of Laplace pressure on the thermodynamic stability of nanobubbles and why this implies that nanobubbles are thermodynamically never stable. Therefore, understanding bubble stability becomes a consideration of the rate of bubble dissolution, so the dominant approach to understanding this is discussed. Bulk nanobubbles (or fine bubbles) are treated separately from surface nanobubbles as this reflects their separate histories. For each class of nanobubbles, we look at the early evidence for their existence, methods for the production and characterization of nanobubbles, evidence that they are indeed gaseous, or otherwise, and theories for their stability. We also look at applications of both surface and bulk nanobubbles.

20 CFR 322.4 - Consideration of evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Consideration of evidence. 322.4 Section 322.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.4 Consideration of evidence. (a) Initial proof. A claimant's certification that he or she...

20 CFR 322.4 - Consideration of evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Consideration of evidence. 322.4 Section 322.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REMUNERATION § 322.4 Consideration of evidence. (a) Initial proof. A claimant's certification that he or she...

In vitro and in vivo models of colorectal cancer: antigenotoxic activity of berries.

PubMed

Brown, Emma M; Latimer, Cheryl; Allsopp, Philip; Ternan, Nigel G; McMullan, Geoffery; McDougall, Gordon J; Stewart, Derek; Crozier, Alan; Rowland, Ian; Gill, Chris I R

2014-05-07

The etiology of colorectal cancer (CRC), a common cause of cancer-related mortality globally, has strong associations with diet. There is considerable epidemiological evidence that fruits and vegetables are associated with reduced risk of CRC. This paper reviews the extensive evidence, both from in vitro studies and animal models, that components of berry fruits can modulate biomarkers of DNA damage and that these effects may be potentially chemoprotective, given the likely role that oxidative damage plays in mutation rate and cancer risk. Human intervention trials with berries are generally consistent in indicating a capacity to significantly decrease oxidative damage to DNA, but represent limited evidence for anticarcinogenicity, relying as they do on surrogate risk markers. To understand the effects of berry consumption on colorectal cancer risk, future studies will need to be well controlled, with defined berry extracts, using suitable and clinically relevant end points and considering the importance of the gut microbiota.

Equations of motion of a space station with emphasis on the effects of the gravity gradient

NASA Technical Reports Server (NTRS)

Tuell, L. P.

1987-01-01

The derivation of the equations of motion is based upon the principle of virtual work. As developed, these equations apply only to a space vehicle whose physical model consists of a rigid central carrier supporting several flexible appendages (not interconnected), smaller rigid bodies, and point masses. Clearly evident in the equations is the respect paid to the influence of the Earth's gravity field, considerably more than has been the custom in simulating vehicle motion. The effect of unpredictable crew motion is ignored.

Predicting workplace aggression and violence.

PubMed

Barling, Julian; Dupré, Kathryne E; Kelloway, E Kevin

2009-01-01

Consistent with the relative recency of research on workplace aggression and the considerable media attention given to high-profile incidents, numerous myths about the nature of workplace aggression have emerged. In this review, we examine these myths from an evidence-based perspective, bringing greater clarity to our understanding of the predictors of workplace aggression. We conclude by pointing to the need for more research focusing on construct validity and prevention issues as well as for methodologies that minimize the likelihood of mono-method bias and that strengthen the ability to make causal inferences.

Downstream Stockton Study, Sac River. Phase 2 Archaeological Test Excavations at Sites 23CE324, 23CE235 and 23CE252 with Discussion of Test Excavation at Sites 23CE240 and 23CE241

DTIC Science & Technology

1988-01-01

area and vicinity. ............ a . . . . . . 34 Table 4. Rodgers Shelter culture sequence and Horizon Projectile Point Series...deposits evidence considerable Holocene aggradation (Brackenridge 1981). This alluvial deposition, referred to as the Rodgers alluvium (Haynes 1977), has...relatively high frequencies of grassland species and small game were exploited at Rodgers Shelter (McMillan 1976b:229), and it was surmised (Kay 1978) that

76 FR 26771 - Florida Power & Light Company; Turkey Point, Units 3 and 4; Notice of Consideration of Issuance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-09

... Company; Turkey Point, Units 3 and 4; Notice of Consideration of Issuance of Amendment to Facility... issued to Florida Power & Light Co. (the licensee) for operation of the Turkey Point Nuclear Generating... licensed core power level for Turkey Point, Units 3 and 4, from 2300 megawatts thermal (MWt) to 2644 MWt...

Some design issues in trials of microbicides for the prevention of HIV infection.

PubMed

Fleming, Thomas R; Richardson, Barbra A

2004-08-15

Trials for the prevention of human immunodeficiency virus (HIV) infection that evaluate microbicides provide significant design challenges. Three of these design issues deserve more careful consideration. The first issue relates to the benefits of using both blinded and unblinded control groups when the placebo regimen may not be inert and when the effectiveness of an intervention heavily depends on behavioral, as well as biological, factors. The second issue relates to the strength of evidence required for regulatory approval for the marketing of drugs and biologics when only a single pivotal phase 3 clinical trial has provided such evidence. The third issue relates to the appropriate next step after the completion of phase 1 trials, as well as the specific merits of conducting phase 2b screening trials that assess the effects on the same clinical efficacy end point that will be the primary end point in a phase 3 trial. The issues considered in microbicide trials for the prevention of HIV infection are also of importance in many other clinical scenarios.

Persistent misunderstandings about evidence-based (sorry: informed!) policy-making.

PubMed

Bédard, Pierre-Olivier; Ouimet, Mathieu

2016-01-01

The field of research on knowledge mobilization and evidence-informed policy-making has seen enduring debates related to various fundamental assumptions such as the definition of 'evidence', the relative validity of various research methods, the actual role of evidence to inform policy-making, etc. In many cases, these discussions serve a useful purpose, but they also stem from serious disagreement on methodological and epistemological issues. This essay reviews the rationale for evidence-informed policy-making by examining some of the common claims made about the aims and practices of this perspective on public policy. Supplementing the existing justifications for evidence-based policy making, we argue in favor of a greater inclusion of research evidence in the policy process but in a structured fashion, based on methodological considerations. In this respect, we present an overview of the intricate relation between policy questions and appropriate research designs. By closely examining the relation between research questions and research designs, we claim that the usual points of disagreement are mitigated. For instance, when focusing on the variety of research designs that can answer a range of policy questions, the common critical claim about 'RCT-based policy-making' seems to lose some, if not all of its grip.

The national health-care agenda in relation to negative pressure wound therapy.

PubMed

Sinha, Surajit; Mudge, Elizabeth

2013-09-01

The NHS was founded upon the principle of providing health care for all, regardless of financial status. However, it has reached a point where patient demands are outgrowing NHS resources, causing conflict. Chronic wound management represents a considerable financial burden on health services in terms of manpower requirement, equipment, specialist opinion, and adjunct therapies, such as negative pressure wound therapy (NPWT). Although funding bodies often perceive NPWT to be expensive, there is evidence that if used appropriately it leads to faster healing, early discharge and better quality of life for patients with chronic wounds. However, it must be acknowledged that the type and quality of studies are mixed. Further evidence is required to justify the use of NPWT in chronic wounds in the primary and secondary health-care setting.

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

PubMed

Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

Evaluating Expected Costs and Benefits of Granting Access to New Treatments on the Basis of Progression-Free Survival in Non-Small-Cell Lung Cancer.

PubMed

Lakdawalla, Darius N; Chou, Jacquelyn W; Linthicum, Mark T; MacEwan, Joanna P; Zhang, Jie; Goldman, Dana P

2015-05-01

Surrogate end points may be used as proxy for more robust clinical end points. One prominent example is the use of progression-free survival (PFS) as a surrogate for overall survival (OS) in trials for oncologic treatments. Decisions based on surrogate end points may expedite regulatory approval but may not accurately reflect drug efficacy. Payers and clinicians must balance the potential benefits of earlier treatment access based on surrogate end points against the risks of clinical uncertainty. To present a framework for evaluating the expected net benefit or cost of providing early access to new treatments on the basis of evidence of PFS benefits before OS results are available, using non-small-cell lung cancer (NSCLC) as an example. A probabilistic decision model was used to estimate expected incremental social value of the decision to grant access to a new treatment on the basis of PFS evidence. The model analyzed a hypothetical population of patients with NSCLC who could be treated during the period between PFS and OS evidence publication. Estimates for delay in publication of OS evidence following publication of PFS evidence, expected OS benefit given PFS benefit, incremental cost of new treatment, and other parameters were drawn from the literature on treatment of NSCLC. Incremental social value of early access for each additional patient per month (in 2014 US dollars). For "medium-value" model parameters, early reimbursement of drugs with any PFS benefit yields an incremental social cost of more than $170,000 per newly treated patient per month. In contrast, granting early access on the basis of PFS benefit between 1 and 3.5 months produces more than $73,000 in incremental social value. Across the full range of model parameter values, granting access for drugs with PFS benefit between 3 and 3.5 months is robustly beneficial, generating incremental social value ranging from $38,000 to more than $1 million per newly treated patient per month, whereas access for all drugs with any PFS benefit is usually not beneficial. The value of providing access to new treatments on the basis of surrogate end points, and PFS in particular, likely varies considerably. Payers and clinicians should carefully consider how to use PFS data in balancing potential benefits against costs in each particular disease.

Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems.

PubMed

Ge, Hong-You

2010-10-01

With the objective evidence of their existence, myofascial trigger points (MTrPs) contribute to an increasing number of chronic regional and widespread pain conditions. The widespread spontaneous pain pattern in fibromyalgia (FM) is a summation of multiple regional pains due to active MTrPs. A regional pain in FM is from local active MTrPs and/or referred from remote active MTrPs. Positive tender points specified in FM are MTrPs, either active or latent. Manual stimulation of active MTrPs located in the muscles in different body regions completely reproduced overall spontaneous FM pain pattern. Active MTrPs as tonic peripheral nociceptive input contribute tremendously to the initiation and maintenance of central sensitization, to the impairment of descending inhibition, to the increased excitability of motor units, and to the induction of sympathetic hyperactivity observed in FM. The considerable overlap of MTrPs and FM in pain characteristics and pathophysiology suggests that FM pain is largely due to MTrPs.

20 CFR 366.5 - Consideration of evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... COLLECTION OF DEBTS BY FEDERAL TAX REFUND OFFSET § 366.5 Consideration of evidence. Evidence submitted by the... of such debt is past-due and legally enforceable will be made only by such officials or employees. ...

Reliability of basal plasma vasopressin concentrations in healthy male adults.

PubMed

Quintana, Daniel S; Westlye, Lars T; Smerud, Knut T; Mahmoud, Ramy A; Djupesland, Per G; Andreassen, Ole A

2017-10-01

The neuropeptides oxytocin (OT) and arginine vasopressin (AVP) play important and interrelated roles in modulating mammalian social behaviour. While the OT system has received considerable research attention for its potential to treat psychiatric symptoms, comparatively little is known about the role of the AVP system in human social behaviour. To better understand the intraindividual stability of basal AVP, the present study assessed the reproducibility of basal plasma AVP concentrations. Basal plasma AVP was assessed at four sampling points separated by 8 days, on average, in 16 healthy adult males. Only one out of six comparisons revealed strong evidence for reproducibility of basal AVP concentrations (visit 2 vs. visit 4: r=0.8, p0.1). The concordance correlation coefficient [0.15, 95% CI (-0.55, 0.73)] also revealed poor overall reproducibility. Poor reliability of basal AVP concentrations suggests future work covarying AVP with trait markers should proceed with careful consideration of intraindividual fluctuations.

On the Importance of Both Dimensional and Discrete Models of Emotion.

PubMed

Harmon-Jones, Eddie; Harmon-Jones, Cindy; Summerell, Elizabeth

2017-09-29

We review research on the structure and functions of emotions that has benefitted from a serious consideration of both discrete and dimensional perspectives on emotion. To illustrate this point, we review research that demonstrates: (1) how affective valence within discrete emotions differs as a function of individuals and situations, and how these differences relate to various functions; (2) that anger (and other emotional states) should be considered as a discrete emotion but there are dimensions around and within anger; (3) that similarities exist between approach-related positive and negative discrete emotions and they have unique motivational functions; (4) that discrete emotions and broad dimensions of emotions both have unique functions; and (5) evidence that a "new" discrete emotion with discrete functions exists within a broader emotion family. We hope that this consideration of both discrete and dimensional perspectives on emotion will assist in understanding the functions of emotions.

On the Importance of Both Dimensional and Discrete Models of Emotion

PubMed Central

Harmon-Jones, Eddie

2017-01-01

We review research on the structure and functions of emotions that has benefitted from a serious consideration of both discrete and dimensional perspectives on emotion. To illustrate this point, we review research that demonstrates: (1) how affective valence within discrete emotions differs as a function of individuals and situations, and how these differences relate to various functions; (2) that anger (and other emotional states) should be considered as a discrete emotion but there are dimensions around and within anger; (3) that similarities exist between approach-related positive and negative discrete emotions and they have unique motivational functions; (4) that discrete emotions and broad dimensions of emotions both have unique functions; and (5) evidence that a “new” discrete emotion with discrete functions exists within a broader emotion family. We hope that this consideration of both discrete and dimensional perspectives on emotion will assist in understanding the functions of emotions. PMID:28961185

Legal issues in the development and use of clinical practice guidelines.

PubMed

Gevers, S

2001-01-01

Over the last ten years, the development and dissemination of practice guidelines has increased at a rapid pace. From a legal point of view, it should always be made clear whether a guideline has been developed to improve the quality of care and is based on medical evidence and professional experience, or whether other concerns and considerations (organisational, financial) did prevail. Guidelines should not simply be imposed on health professionals; that would result in a standardisation of care that does no justice to individual patient needs and preferences. Patients have the right to be informed about reasonable and realistic treatment alternatives, even if they are not included in the guideline. Using cost effectiveness analysis in guideline development can help to reduce care of dubious effectiveness. But if cost considerations are used as a reason to limit effective medical care, the guidelines in question need political legitimation.

Knowledge 'Translation' as social learning: negotiating the uptake of research-based knowledge in practice.

PubMed

Salter, K L; Kothari, A

2016-02-29

Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles. The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.

Light-cone velocities after a global quench in a noninteracting model

NASA Astrophysics Data System (ADS)

Najafi, K.; Rajabpour, M. A.; Viti, J.

2018-05-01

We study the light-cone velocity for global quenches in the noninteracting XY chain starting from a class of initial states that are eigenstates of the local z component of the spin. We point out how translation invariance of the initial state can affect the maximal speed at which correlations spread. As a consequence the light-cone velocity can be state dependent also for noninteracting systems: a new effect of which we provide clear numerical evidence and analytic predictions. Analogous considerations, based on numerical results, are drawn for the evolution of the entanglement entropy.

Afterword: Considerations for Future Practice of Assessment and Accountability

ERIC Educational Resources Information Center

Bresciani, Marilee J.

2013-01-01

This afterword offers challenges and considerations as the assessment movement continues to develop. The author offers some simple considerations for readers to ponder as they advance their evidence-based decision making processes, and encourages others to use these methods within the context of recent neuroscientific evidence that learning and…

Methodological challenges for the evaluation of clinical effectiveness in the context of accelerated regulatory approval: an overview.

PubMed

Woolacott, Nerys; Corbett, Mark; Jones-Diette, Julie; Hodgson, Robert

2017-10-01

Regulatory authorities are approving innovative therapies with limited evidence. Although this level of data is sufficient for the regulator to establish an acceptable risk-benefit balance, it is problematic for downstream health technology assessment, where assessment of cost-effectiveness requires reliable estimates of effectiveness relative to existing clinical practice. Some key issues associated with a limited evidence base include using data, from nonrandomized studies, from small single-arm trials, or from single-center trials; and using surrogate end points. We examined these methodological challenges through a pragmatic review of the available literature. Methods to adjust nonrandomized studies for confounding are imperfect. The relative treatment effect generated from single-arm trials is uncertain and may be optimistic. Single-center trial results may not be generalizable. Surrogate end points, on average, overestimate treatment effects. Current methods for analyzing such data are limited, and effectiveness claims based on these suboptimal forms of evidence are likely to be subject to significant uncertainty. Assessments of cost-effectiveness, based on the modeling of such data, are likely to be subject to considerable uncertainty. This uncertainty must not be underestimated by decision makers: methods for its quantification are required and schemes to protect payers from the cost of uncertainty should be implemented. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Tipping Points in Resource Abundance Drive Irreversible Changes in Community Structure.

PubMed

Haney, Seth D; Siepielski, Adam M

2018-05-01

Global climate change has made what were seemingly extraordinary environmental conditions, such as prolonged droughts, commonplace. One consequence of extreme environmental change is concomitant changes in resource abundance. How will such extreme resource changes impact biodiversity? We developed a trait-based consumer-resource model to examine how resource abundance affects the potential for adaptive evolution and coexistence among competitors. We found that moderate changes in resource abundance have little effect on trait evolution. However, when resource scarcities were sufficiently extreme, a critical transition-a tipping point-occurred, which caused consumer traits to diverge and restructured the community in a way that outlasted the scarcity. Therefore, even though traits can evolve in response to minor resource fluctuations, large environmental shifts may be necessary for producing long-lasting impacts on community structure. These results may also help to illuminate patterns of stasis frequently observed in nature, despite the considerable evidence demonstrating rapid evolutionary change.

Governance and community benefit: are nonprofit hospitals good candidates for Sarbanes-Oxley type reforms?

PubMed

Alexander, Jeffrey A; Young, Gary J; Weiner, Bryan J; Hearld, Larry R

2008-04-01

Recent investigations into the activities of nonprofit hospitals have pointed to weak or lax governance on the part of some of these organizations. As a result of these events, various federal and state initiatives are now either under way or under discussion to strengthen the governance of hospitals and other nonprofit corporations through mandatory board structures and practices. However, despite policy makers' growing interest in these types of governance reforms, there is in fact little empirical evidence to support their contribution to the effectiveness of hospital boards. The purpose of this article is to report the results of a study examining the relationship between the structure and practices of nonprofit hospital boards relative to the hospital's provision of community benefits. Our results point to modest relationships between these sets of variables, suggesting considerable limitations to what federal and state policy makers can accomplish through legislative initiatives to improve the governance of nonprofit hospitals.

Visualization of the Construction of Ancient Roman Buildings in Ostia Using Point Cloud Data

NASA Astrophysics Data System (ADS)

Hori, Y.; Ogawa, T.

2017-02-01

The implementation of laser scanning in the field of archaeology provides us with an entirely new dimension in research and surveying. It allows us to digitally recreate individual objects, or entire cities, using millions of three-dimensional points grouped together in what is referred to as "point clouds". In addition, the visualization of the point cloud data, which can be used in the final report by archaeologists and architects, should usually be produced as a JPG or TIFF file. Not only the visualization of point cloud data, but also re-examination of older data and new survey of the construction of Roman building applying remote-sensing technology for precise and detailed measurements afford new information that may lead to revising drawings of ancient buildings which had been adduced as evidence without any consideration of a degree of accuracy, and finally can provide new research of ancient buildings. We used laser scanners at fields because of its speed, comprehensive coverage, accuracy and flexibility of data manipulation. Therefore, we "skipped" many of post-processing and focused on the images created from the meta-data simply aligned using a tool which extended automatic feature-matching algorithm and a popular renderer that can provide graphic results.

Preliminary survey of the saline-water resources of the United States

USGS Publications Warehouse

Krieger, Robert A.; Hatchett, J.L.; Poole, J.L.

1957-01-01

Basic hydrologic data available in the field offices of the U. S. Geological Survey and reports issued by the Survey furnish evidence that saline water (defined in this report as water containing more than 1,000 parts per million of dissolved solids) is available under diverse geologic and hydrologic conditions throughout the United States.The number of areas in which undeveloped supplies of fresh water are available has diminished considerably with the rapid growth of industries and population in the past decade. Many areas previously considered to have relatively unlimited water resources have reached the point at which water-supply shortages exist or are threatened.

Producing and understanding prosocial actions in early childhood.

PubMed

Paulus, Markus; Moore, Chris

2012-01-01

Early prosocial development has become a topic of great interest in recent years as experimental studies have provided evidence that instances of prosocial action can already be found in the second year of life. In this contribution, we review the recent literature on young children's production of prosocial actions, in particular helping, sharing, and comforting, and their understanding of others' prosocial behavior. We summarize the novel insights gained by recent studies and point to directions for future studies. Overall, we suggest that while the field consists of considerable knowledge about the developmental timeline of prosocial behavior, more research is needed to examine and better understand underlying social-cognitive mechanisms.

Social Learning Theory and Behavioral Therapy: Considering Human Behaviors within the Social and Cultural Context of Individuals and Families.

PubMed

McCullough Chavis, Annie

2011-01-01

This article examines theoretical thoughts of social learning theory and behavioral therapy and their influences on human behavior within a social and cultural context. The article utilizes two case illustrations with applications for consumers. It points out the abundance of research studies concerning the effectiveness of social learning theory, and the paucity of research studies regarding effectiveness and evidence-based practices with diverse groups. Providing a social and cultural context in working with diverse groups with reference to social learning theory adds to the literature for more cultural considerations in adapting the theory to women, African Americans, and diverse groups.

What is the role of procedural justice in civil commitment?

PubMed

McKenna, B G; Simpson, A I; Coverdale, J H

2000-08-01

To determine best practice management strategies in the clinical application of civil commitment. All relevant literature on the topics of 'civil commitment', 'coercion' and 'procedural justice' were located on MEDLINE and PsychLIT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

[Methodology for the development of policy brief in public health].

PubMed

Felt, Emily; Carrasco, José Miguel; Vives-Cases, Carmen

2018-01-10

A policy brief is a document that summarizes research to inform policy. In a brief and succinct way, it defines a policy problem, presents a synthesis of relevant evidence, identifies possible courses of action and makes recommendations or key points. The objective of this note is to describe the methodology used to produce a policy brief for communicating public health research. This note is based on the model presented by Eugene Bardach in addition to the authors' own experiences. We describe six steps: 1) identifying the audience; 2) defining the problem; 3) gathering information and evidence; 4) consideration of policy alternatives; 5) projecting results and designing recommendations; and 6) telling the story. We make a case for the use of policy briefs as a part of an overall communications strategy for research that aims to bring together research teams and stakeholders. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The aetiology of obesity beyond eating more and exercising less.

PubMed

Dhurandhar, Emily J; Keith, Scott W

2014-08-01

Although recent increases in availability of energy dense, processed foods and reductions in institutionally driven physical activity have created an environment that is permissible for obesity to occur, several other factors may contribute to the development of obesity in this context. We review evidence for eleven such factors: endocrine disruptors, intrauterine effects, epigenetics, maternal age, differential fecundity and assortative mating by body mass index, microorganisms, reduction in variability of ambient temperatures, smoking cessation, sleep debt, and pharmaceutical iatrogenesis. Evidence for the role of endocrine disruptors, microorganisms, ambient temperatures, sleep and reproductive factors is accumulating, but additional research is needed to confirm the causative role of these factors in human obesity. However, the role of certain pharmaceuticals and smoking cessation in development of human obesity is clear. Practice points for consideration and future research needed are highlighted for each factor. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decision Points and Considerations for Identifying Rural Districts That Have Closed Student Achievement Gaps. REL 2016-130

ERIC Educational Resources Information Center

Culbertson, Michael J.; Billig, Shelley H.

2016-01-01

Rural districts have long faced challenges in closing achievement gaps between subgroups of students. This brief report describes key decision points and considerations for decision-makers interested in identifying rural districts that have closed academic achievement gaps. Examining practices in these districts may suggest activities associated…

Development of biological and nonbiological explanations for the Viking label release data. [hydrogen peroxide theory

NASA Technical Reports Server (NTRS)

1980-01-01

The plausibility that hydrogen peroxide, widely distributed within the Mars surface material, was responsible for the evocative response obtained by the Viking Labeled Release (LR) experiment on Mars was investigated. Although a mixture of gamma Fe2O3 and silica sand stimulated the LR nutrient reaction with hydrogen peroxide and reduced the rate of hydrogen decomposition under various storage conditions, the Mars analog soil prepared by the Viking Inorganic Analysis Team to match the Mars analytical data does not cause such effects. Nor is adequate resistance to UV irradiation shown. On the basis of the results and consideration presented while the hydrogen peroxide theory remains the most, if not only, attractive chemical explanation of the LR data, it remains unconvincing on critical points. Until problems concerning the formation and stabilization of hydrogen peroxide on the surface of Mars can be overcome, adhere to the scientific evidence requires serious consideration of the biological theory.

Quasi-experimental designs in practice-based research settings: design and implementation considerations.

PubMed

Handley, Margaret A; Schillinger, Dean; Shiboski, Stephen

2011-01-01

Although randomized controlled trials are often a gold standard for determining intervention effects, in the area of practice-based research (PBR), there are many situations in which individual randomization is not possible. Alternative approaches to evaluating interventions have received increased attention, particularly those that can retain elements of randomization such that they can be considered "controlled" trials. Methodological design elements and practical implementation considerations for two quasi-experimental design approaches that have considerable promise in PBR settings--the stepped-wedge design, and a variant of this design, a wait-list cross-over design, are presented along with a case study from a recent PBR intervention for patients with diabetes. PBR-relevant design features include: creation of a cohort over time that collects control data but allows all participants (clusters or patients) to receive the intervention; staggered introduction of clusters; multiple data collection points; and one-way cross-over into the intervention arm. Practical considerations include: randomization versus stratification, training run in phases; and extended time period for overall study completion. Several design features of practice based research studies can be adapted to local circumstances yet retain elements to improve methodological rigor. Studies that utilize these methods, such as the stepped-wedge design and the wait-list cross-over design, can increase the evidence base for controlled studies conducted within the complex environment of PBR.

29 CFR 1650.205 - Consideration of evidence submitted as a result of notification of intent.

Code of Federal Regulations, 2010 CFR

2010-07-01

... notification of intent. 1650.205 Section 1650.205 Labor Regulations Relating to Labor (Continued) EQUAL...) Consideration of evidence. If, as a result of the notification of intent, EEOC receives notice that the debtor... time period, collection will be stayed until EEOC: (1) Considers the evidence presented by the debtor...

29 CFR 1650.205 - Consideration of evidence submitted as a result of notification of intent.

Code of Federal Regulations, 2011 CFR

2011-07-01

... notification of intent. 1650.205 Section 1650.205 Labor Regulations Relating to Labor (Continued) EQUAL...) Consideration of evidence. If, as a result of the notification of intent, EEOC receives notice that the debtor... time period, collection will be stayed until EEOC: (1) Considers the evidence presented by the debtor...

29 CFR 1650.205 - Consideration of evidence submitted as a result of notification of intent.

Code of Federal Regulations, 2012 CFR

2012-07-01

... notification of intent. 1650.205 Section 1650.205 Labor Regulations Relating to Labor (Continued) EQUAL...) Consideration of evidence. If, as a result of the notification of intent, EEOC receives notice that the debtor... time period, collection will be stayed until EEOC: (1) Considers the evidence presented by the debtor...

29 CFR 1650.205 - Consideration of evidence submitted as a result of notification of intent.

Code of Federal Regulations, 2013 CFR

2013-07-01

... notification of intent. 1650.205 Section 1650.205 Labor Regulations Relating to Labor (Continued) EQUAL...) Consideration of evidence. If, as a result of the notification of intent, EEOC receives notice that the debtor... time period, collection will be stayed until EEOC: (1) Considers the evidence presented by the debtor...

29 CFR 1650.205 - Consideration of evidence submitted as a result of notification of intent.

Code of Federal Regulations, 2014 CFR

2014-07-01

... notification of intent. 1650.205 Section 1650.205 Labor Regulations Relating to Labor (Continued) EQUAL...) Consideration of evidence. If, as a result of the notification of intent, EEOC receives notice that the debtor... time period, collection will be stayed until EEOC: (1) Considers the evidence presented by the debtor...

Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making?

PubMed

Florkowski, Christopher; Don-Wauchope, Andrew; Gimenez, Nuria; Rodriguez-Capote, Karina; Wils, Julien; Zemlin, Annalise

Point-of-care testing (POCT) is the analysis of patient specimens outside the clinical laboratory, near or at the site of patient care, usually performed by clinical staff without laboratory training, although it also encompasses patient self-monitoring. It is able to provide a rapid result near the patient and which can be acted upon immediately. The key driver is the concept that clinical decision making may be delayed when samples are sent to the clinical laboratory. Balanced against this are considerations of increased costs for purchase and maintenance of equipment, staff training, connectivity to the laboratory information system (LIS), quality control (QC) and external quality assurance (EQA) procedures, all required for accreditation under ISO 22870. The justification for POCT depends upon being able to demonstrate that a more timely result (shorter turnaround times (TATs)) is able to leverage a clinically important advantage in decision making compared with the central laboratory (CL). In the four decades since POCT was adapted for the self-monitoring of blood glucose levels by subjects with diabetes, numerous new POCT methodologies have become available, enabling the clinician to receive results and initiate treatment more rapidly. However, these instruments are often operated by staff not trained in laboratory medicine and hence are prone to errors in the analytical phase (as opposed to laboratory testing where the analytical phase has the least errors). In some environments, particularly remote rural settings, the CL may be at a considerable distance and timely availability of cardiac troponins and other analytes can triage referrals to the main centers, thus avoiding expensive unnecessary patient transportation costs. However, in the Emergency Department, availability of more rapid results with POCT does not always translate into shorter stays due to other barriers to implementation of care. In this review, we apply the principles of evidence-based laboratory medicine (EBLM) looking for high quality systematic reviews and meta-analyses, ideally underpinned by randomized controlled trials (RCTs), looking for evidence of whether POCT confers any advantage in clinical decision making in different scenarios.

A Longitudinal Study of Fathers' and Young Children's Depressive Symptoms.

PubMed

Tichovolsky, Marianne H; Griffith, Shayl F; Rolon-Arroyo, Benjamin; Arnold, David H; Harvey, Elizabeth A

2016-09-21

Considerable research has examined the effects of maternal depression on children, but few studies have focused on the relation between paternal and child depressive symptoms, particularly during early childhood. Even fewer studies have been longitudinal, leaving open questions about how paternal and child depression covary over time. The present study sought to address this gap by examining the relation between fathers' and children's depressive symptoms over a 3-year period. Participants were 153 preschool children with behavior problems and their parents. Three longitudinal analytic approaches were used to examine how father and child depression change together and predict one another over time. Additional analyses examined whether externalizing problems or maternal depression might account for the associations between fathers' and children's depressive symptoms. Changes in paternal depression significantly predicted changes in father-reported and mother-reported child depressive symptoms. These effects were evident both in year-to-year fluctuations and in linear trajectories across the 3-year period. Cross-lagged analyses suggested that these relations may have been driven by father-effects; paternal depression at one time point predicted child depression at the next time point, but child depression did not significantly predict later paternal depression. We found little evidence that externalizing problems or maternal depression accounted for the relations between fathers' and children's depressive symptoms. Results provide convergent evidence that fathers' depression may play an important role in the development of depressive symptoms in young children and underscore the importance of including fathers in studies of depression in families.

Simulators for Mariner Training and Licensing. Phase 2: Investigation of Simulator-Based Training for Maritime Cadets,

DTIC Science & Technology

1981-10-01

a balance was drawn between experimental considerations (e.g., pretests and posttests ) and training process considerations (e.g., available time and...Station 23 4 Instructor’s Checkoff List 24 5 Port Approach Area 26 6 Training Unit Schedule 28 7 Pretest / Posttest Comparison: CPA - Kings Point Group A (Day...39 a Pretest / Posttest Comparison: Number of Radar Requests - Kings Point Group A (Day) 41 9 Input Characteristic Range Master Notified, Kings Point

Cost Effectiveness of Malaria Interventions from Preelimination through Elimination: a Study in Iran.

PubMed

Rezaei-Hemami, Mohsen; Akbari-Sari, Ali; Raiesi, Ahmad; Vatandoost, Hassan; Majdzadeh, Reza

2014-01-01

Malaria still is considered as a public health problem in Iran. The aim of the National Malaria Control Department is to reach the elimination by 2024. By decreasing the number of malaria cases in preelimination phase the cost effectiveness of malaria interventions decreases considerably. This study estimated the cost effectiveness of various strategies to combat malaria in preelimination and elimination phases in Iran. running costs of the interventions at each level of intervention was estimated by using evidence and expert opinions. The effect of each intervention was estimated using the documentary evidence available and expert opinions. Using a point estimate and distribution of each variable the sensitivity was evaluated with the Monte Carlo method. The most cost-effective interventions were insecticide treated net (ITN), larviciding, surveillance for diagnosis and treatment of patients less than 24 hours, and indoor residual spraying (IRS) respectively, No related evidence found for the effectiveness of the border facilities. This study showed that interventions in the elimination phase of malaria have low cost effectiveness in Iran like many other countries. However ITN is the most cost effective intervention among the available interventions.

Can conditional cash transfers improve the uptake of nutrition interventions and household food security? Evidence from Odisha’s Mamata scheme

PubMed Central

2017-01-01

There is considerable global evidence on the effectiveness of cash transfers in improving health and nutrition outcomes; however, the evidence from South Asia, particularly India, is limited. In the context of India where more than a third of children are undernourished, and where there is considerable under-utilization of health and nutrition interventions, it is opportune to investigate the impact of cash transfer programs on the use of interventions. We study one conditional cash transfer program, Mamata scheme, implemented in the state of Odisha, in India that targeted pregnant and lactating women. Using survey data on 1161 households from three districts in the state of Odisha, we examine the effect of the scheme on eight outcomes: 1) pregnancy registration; 2) receipt of antenatal services; 3) receipt of iron and folic acid (IFA) tablets; 4) exposure to counseling during pregnancy; 5) exposure to postnatal counseling; 6) exclusive breastfeeding; 7) full immunization; and 8) household food security. We conduct regression analyses and correct for endogeneity using nearest-neighbor matching and inverse-probability weighting models. We find that the receipt of payments from the Mamata scheme is associated with a 5 percentage point (pp) increase in the likelihood of receiving antenatal services, a 10 pp increase in the likelihood of receiving IFA tablets, and a decline of 0.84 on the Household Food Insecurity Access Scale. These results provide the first quantitative estimates of effects associated with the Mamata scheme, which can inform the design of government policies related to conditional cash transfers. PMID:29228022

On the weathering of Martian igneous rocks

NASA Technical Reports Server (NTRS)

Dreibus, G.; Waenke, H.

1992-01-01

Besides the young crystallization age, one of the first arguments for the martian origin of shergottite, nakhlite, and chassignite (SNC) meteorites came from the chemical similarity of the meteorite Shergotty and the martian soil as measured by Viking XRF analyses. In the meantime, the discovery of trapped rare gas and nitrogen components with element and isotope ratios closely matching the highly characteristic ratios of the Mars atmosphere in the shock glasses of shergottite EETA79001 was further striking evidence that the SNC's are martian surface rocks. The martian soil composition as derived from the Viking mission, with its extremely high S and Cl concentrations, was interpreted as weathering products of mafic igneous rocks. The low SiO2 content and the low abundance of K and other trace elements in the martian soils point to a mafic crust with a considerably smaller degree of fractionation compared to the terrestrial crust. However, the chemical evolution of the martian regolith and soil in respect to surface reaction with the planetary atmosphere or hydrosphere is poorly understood. A critical point in this respect is that the geochemical evidence as derived from the SNC meteorites suggests that Mars is a very dry planet that should have lost almost all its initially large water inventory during its accretion.

A method for assessing the cost-effectiveness and the break-even point of clinical practice guidelines.

PubMed

Gandjour, A; Lauterbach, K W

2001-01-01

Assessing the costs and benefits of developing a clinical practice guideline is important because investments in guidelines compete with investments in other clinical programs. Despite the considerable number of guidelines in many industrialized countries, little is known about their costs and cost-effectiveness. The authors have developed specific measures to determine the cost-effectiveness of guidelines, using a German evidence-based guideline on obesity for the diagnosis and treatment of obese patients as a model. The measures are: the number of people needed to cure, the number of people needed to prevent from developing the disease in question, and the number of people to treat in order to break even.

L: How Long Do They Last?

NASA Astrophysics Data System (ADS)

Shostak, Seth

The Drake equation, a commonly-used starting point for discussions about the likelihood of finding extraterrestrial intelligence, is now nearly a halfcentury old. It dates from 1961, a year after Frank Drake made his pioneering radio search for artificial signals from other worlds. That search, dubbed Project Ozma, was a 200-hour scrutiny of two nearby, Sun-like stars for transmissions spectrally situated near the 1420 MHz line of neutral hydrogen, and was conducted with an 85-foot antenna at the National Radio Astronomy Observatory in Green Bank, West Virginia (Drake, 1960; Kellermann and Seielstad, 1986). These efforts to find easy evidence of intelligence in other star systems provoked considerable public interest, including a major article in Saturday Review (Lear, 1960).

The forensic aspects of sexual violence.

PubMed

Newton, Mary

2013-02-01

Complainants of sexual assault may disclose to different agencies, the police and health professionals being the most likely. It is possible for certain evidence types to be collected before a clinical forensic assessment takes place that do not require the need for a Forensic Medical Practitioner. If the time frames after the incident and the nature of assault warrant the need for a forensic medical examination of either a complainant or a suspect, this should only be conducted by doctors and nurses who have received relevant, up-to-date specialist theoretical and practical training. Clear evidence shows that few other criminal offences require as extensive an examination and collection of forensic evidence as that of a sexual assault. The forensic evidence in a case may identify an assailant, eliminate a nominated suspect(s), and assist in the prosecution of a case. The elements of forensic medical examination, reviewed in this chapter, are those that are the most varied across jurisdictions around the world currently. Key focus points of this chapter are considerations for early evidence collection, utilising dedicated medical examination facilities for sample collection, contamination issues associated with evidence collection and certain practical aspects of forensic sampling methods which have evolved given results identified by Forensic Scientists processing evidential samples in sexual assault cases, Some of the problems encountered by the forensic science provider will also be discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

An aggregate method to calibrate the reference point of cumulative prospect theory-based route choice model for urban transit network

NASA Astrophysics Data System (ADS)

Zhang, Yufeng; Long, Man; Luo, Sida; Bao, Yu; Shen, Hanxia

2015-12-01

Transit route choice model is the key technology of public transit systems planning and management. Traditional route choice models are mostly based on expected utility theory which has an evident shortcoming that it cannot accurately portray travelers' subjective route choice behavior for their risk preferences are not taken into consideration. Cumulative prospect theory (CPT), a brand new theory, can be used to describe travelers' decision-making process under the condition of uncertainty of transit supply and risk preferences of multi-type travelers. The method to calibrate the reference point, a key parameter to CPT-based transit route choice model, determines the precision of the model to a great extent. In this paper, a new method is put forward to obtain the value of reference point which combines theoretical calculation and field investigation results. Comparing the proposed method with traditional method, it shows that the new method can promote the quality of CPT-based model by improving the accuracy in simulating travelers' route choice behaviors based on transit trip investigation from Nanjing City, China. The proposed method is of great significance to logical transit planning and management, and to some extent makes up the defect that obtaining the reference point is solely based on qualitative analysis.

Evidence-Based Design of Fixed-Dose Combinations: Principles and Application to Pediatric Anti-Tuberculosis Therapy.

PubMed

Svensson, Elin M; Yngman, Gunnar; Denti, Paolo; McIlleron, Helen; Kjellsson, Maria C; Karlsson, Mats O

2018-05-01

Fixed-dose combination formulations where several drugs are included in one tablet are important for the implementation of many long-term multidrug therapies. The selection of optimal dose ratios and tablet content of a fixed-dose combination and the design of individualized dosing regimens is a complex task, requiring multiple simultaneous considerations. In this work, a methodology for the rational design of a fixed-dose combination was developed and applied to the case of a three-drug pediatric anti-tuberculosis formulation individualized on body weight. The optimization methodology synthesizes information about the intended use population, the pharmacokinetic properties of the drugs, therapeutic targets, and practical constraints. A utility function is included to penalize deviations from the targets; a sequential estimation procedure was developed for stable estimation of break-points for individualized dosing. The suggested optimized pediatric anti-tuberculosis fixed-dose combination was compared with the recently launched World Health Organization-endorsed formulation. The optimized fixed-dose combination included 15, 36, and 16% higher amounts of rifampicin, isoniazid, and pyrazinamide, respectively. The optimized fixed-dose combination is expected to result in overall less deviation from the therapeutic targets based on adult exposure and substantially fewer children with underexposure (below half the target). The development of this design tool can aid the implementation of evidence-based formulations, integrating available knowledge and practical considerations, to optimize drug exposures and thereby treatment outcomes.

AChE Inhibitors and NMDA Receptor Antagonists in Advanced Alzheimer's Disease.

PubMed

Glynn-Servedio, Brianna E; Ranola, Trisha Seys

2017-09-01

The objective of this article is to review the available evidence for duration of treatment with, and considerations for discontinuation of, acetylcholinesterase inhibitors and N-methyl-d-aspartate receptor antagonists in Alzheimer's disease. Literature searches of clinical trials and meta-analyses were conducted using PubMed with the search terms Alzheimer's, dementia, donepezil, galantamine, memantine, and rivastigmine. References from included trials were also used to find additional citations. 2,925 articles were initially identified. Twenty-one studies were included that looked at the use of acetylcholinesterase inhibitors and/or memantine in the treatment of moderate-to-severe Alzheimer's dementia. Several clinical trials have demonstrated small improvements in measures of cognition and activities of daily living with medications used to treat dementia. However, not all patients will benefit from treatment, and the impact of treatment on long-term outcomes, including institutionalization, remains unclear. This paper reviews the available data to support the use of acetylcholinesterase inhibitors and/or memantine in patients with advanced Alzheimer's disease, including those in nursing facilities, and reviews recommendations for consideration of therapy discontinuation. The evidence to support a specific time frame for discontinuation of Alzheimer's disease treatment is limited. It is reasonable to stop a medication if there is no noticeable benefit after the first three months of treatment or once a patient's dementia progresses to a point where there would be no meaningful benefit from continued therapy.

What doesn't kill you makes you poorer: Adult wages and early-life mortality in India.

PubMed

Lawson, Nicholas; Spears, Dean

2016-05-01

A growing literature indicates that effects of early-life health on adult economic outcomes could be substantial in developing countries, but the magnitude of this effect is debated. We document a robust gradient between the early-life mortality environment to which men in India were locally exposed in their district and year of birth and the wages that they earn as adults. A 1 percentage point reduction in infant mortality (or 10 point reduction in IMR) in an infant's district and year of birth is associated with an approximately 2 percent increase in his subsequent adult wages. Consistent with theories and evidence in the literature, we find that the level of schooling chosen for a child does not mediate this association. Because of its consequences for subsequent wages, early-life health could also have considerable fiscal externalities; if so, public health investments could come at very low net present cost. Copyright © 2015 Elsevier B.V. All rights reserved.

20 CFR 405.373 - Requesting consideration of new evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Requesting consideration of new evidence. 405.373 Section 405.373 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS... you; (2) You had a physical, mental, educational, or linguistic limitation(s) that prevented you from...

Drafting guidelines for occupational exposure to chemicals: the Dutch experience with the assessment of reproductive risks.

PubMed

Stijkel, A; van Eijndhoven, J C; Bal, R

1996-12-01

The Dutch procedure for standard setting for occupational exposure to chemicals, just like the European Union (EU) procedure, is characterized by an organizational separation between considerations of health on the one side, and of technology, economics, and policy on the other side. Health considerations form the basis for numerical guidelines. These guidelines are next combined with technical-economical considerations. Standards are then proposed, and are finally set by the Ministry of Social Affairs and Employment. An analysis of this procedure might be of relevance to the US, where other procedures are used and criticized. In this article we focus on the first stage of the standard-setting procedure. In this stage, the Dutch Expert Committee on Occupational Standards (DECOS) drafts a criteria document in which a health-based guideline is proposed. The drafting is based on a set of starting points for assessing toxicity. We raise the questions, "Does DECOS limit itself only to health considerations? And if not, what are the consequences of such a situation?" We discuss DECOS' starting points and analyze the relationships between those starting points, and then explore eight criteria documents where DECOS was considering reproductive risks as a possible critical effect. For various reasons, it will be concluded that the starting points leave much interpretative space, and that this space is widened further by the manner in which DECOS utilizes it. This is especially true in situations involving sex-specific risks and uncertainties in knowledge. Consequently, even at the first stage, where health considerations alone are intended to play a role, there is much room for other than health-related factors to influence decision making, although it is unavoidable that some interpretative space will remain. We argue that separating the various types of consideration should not be abandoned. Rather, through adjustments in the starting points and aspects of the procedure, clarity should be guaranteed about the way the interpretative space is being employed.

Increasing scientific confidence in adverse outcome pathways: Application of tailored Bradford-Hill considerations for evaluating weight of evidence

EPA Science Inventory

Systematic consideration of scientific support is a critical element in developing and, ultimately, using adverse outcome pathways (AOPs) for various regulatory applications. Though weight of evidence (WoE) analysis has been proposed as a basis for assessment of the maturity and...

Nephrotic syndrome and neoplasm. The findings to date, with practical implications.

PubMed

Papper, S

1984-11-01

The following points should be kept in mind in cases of nephrotic syndrome. Neoplasm (malignant or benign) occurs in approximately 10% of adults with nephrotic syndrome (15% of those over age 60). The neoplasm may be evident before, after, or simultaneously with the development of the nephrotic syndrome. Minimal change lesion in the kidney suggests possible Hodgkin's disease, while membranous nephropathy is more suggestive of possible carcinoma, although there are many exceptions to this generalization. Membrano-proliferative and focal sclerosis renal lesions also occur with diverse tumors. Strong evidence exists that in cases of carcinoma and nephrotic syndrome, the renal lesion is generally due to immune complexes--either tumor-associated antigens, fetal antigens, or viral antigens. In cases involving Hodgkin's disease, T-cell deficiency may be relevant in the genesis of the minimal change lesion and the nephrotic syndrome. Nephrotic syndrome often responds to effective treatment of the tumor and commonly recurs with relapse of the neoplasm. Nephrotic syndrome without apparent cause in an adult compels consideration of an associated neoplasm.

A total-evidence approach to dating with fossils, applied to the early radiation of the hymenoptera.

PubMed

Ronquist, Fredrik; Klopfstein, Seraina; Vilhelmsen, Lars; Schulmeister, Susanne; Murray, Debra L; Rasnitsyn, Alexandr P

2012-12-01

Phylogenies are usually dated by calibrating interior nodes against the fossil record. This relies on indirect methods that, in the worst case, misrepresent the fossil information. Here, we contrast such node dating with an approach that includes fossils along with the extant taxa in a Bayesian total-evidence analysis. As a test case, we focus on the early radiation of the Hymenoptera, mostly documented by poorly preserved impression fossils that are difficult to place phylogenetically. Specifically, we compare node dating using nine calibration points derived from the fossil record with total-evidence dating based on 343 morphological characters scored for 45 fossil (4--20 complete) and 68 extant taxa. In both cases we use molecular data from seven markers (∼5 kb) for the extant taxa. Because it is difficult to model speciation, extinction, sampling, and fossil preservation realistically, we develop a simple uniform prior for clock trees with fossils, and we use relaxed clock models to accommodate rate variation across the tree. Despite considerable uncertainty in the placement of most fossils, we find that they contribute significantly to the estimation of divergence times in the total-evidence analysis. In particular, the posterior distributions on divergence times are less sensitive to prior assumptions and tend to be more precise than in node dating. The total-evidence analysis also shows that four of the seven Hymenoptera calibration points used in node dating are likely to be based on erroneous or doubtful assumptions about the fossil placement. With respect to the early radiation of Hymenoptera, our results suggest that the crown group dates back to the Carboniferous, ∼309 Ma (95% interval: 291--347 Ma), and diversified into major extant lineages much earlier than previously thought, well before the Triassic. [Bayesian inference; fossil dating; morphological evolution; relaxed clock; statistical phylogenetics.].

A Total-Evidence Approach to Dating with Fossils, Applied to the Early Radiation of the Hymenoptera

PubMed Central

Ronquist, Fredrik; Klopfstein, Seraina; Vilhelmsen, Lars; Schulmeister, Susanne; Murray, Debra L.; Rasnitsyn, Alexandr P.

2012-01-01

Abstract Phylogenies are usually dated by calibrating interior nodes against the fossil record. This relies on indirect methods that, in the worst case, misrepresent the fossil information. Here, we contrast such node dating with an approach that includes fossils along with the extant taxa in a Bayesian total-evidence analysis. As a test case, we focus on the early radiation of the Hymenoptera, mostly documented by poorly preserved impression fossils that are difficult to place phylogenetically. Specifically, we compare node dating using nine calibration points derived from the fossil record with total-evidence dating based on 343 morphological characters scored for 45 fossil (4--20 complete) and 68 extant taxa. In both cases we use molecular data from seven markers (∼5 kb) for the extant taxa. Because it is difficult to model speciation, extinction, sampling, and fossil preservation realistically, we develop a simple uniform prior for clock trees with fossils, and we use relaxed clock models to accommodate rate variation across the tree. Despite considerable uncertainty in the placement of most fossils, we find that they contribute significantly to the estimation of divergence times in the total-evidence analysis. In particular, the posterior distributions on divergence times are less sensitive to prior assumptions and tend to be more precise than in node dating. The total-evidence analysis also shows that four of the seven Hymenoptera calibration points used in node dating are likely to be based on erroneous or doubtful assumptions about the fossil placement. With respect to the early radiation of Hymenoptera, our results suggest that the crown group dates back to the Carboniferous, ∼309 Ma (95% interval: 291--347 Ma), and diversified into major extant lineages much earlier than previously thought, well before the Triassic. [Bayesian inference; fossil dating; morphological evolution; relaxed clock; statistical phylogenetics.] PMID:22723471

The Navigation Guide systematic review methodology: a rigorous and transparent method for translating environmental health science into better health outcomes.

PubMed

Woodruff, Tracey J; Sutton, Patrice

2014-10-01

Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years. We sought to develop a proof of concept of the "Navigation Guide," a systematic and transparent method of research synthesis in environmental health. The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of "risk of bias," and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a "moderate" quality rating to human observational studies and combining diverse evidence streams. The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm.

The Department of Defense Shale Oil Task Force. Volume I.

DTIC Science & Technology

1978-10-05

transition from natural crude to synthetic fuels during the time period 1985-2010. The report also points out that shale-derived military mobility fuel is...transition from natural crude to synthetic fuels during the time period 1985-201)1. The report also points out that shale-derived military mobility...with emphasis on comparative economics, environmental and timing considerations. o Industrial considerations. o Research and development on new

Evidence-based prosthodontics: fundamental considerations, limitations, and guidelines.

PubMed

Bidra, Avinash S

2014-01-01

Evidence-based dentistry is rapidly emerging to become an integral part of patient care, dental education, and research. Prosthodontics is a unique dental specialty that encompasses art, philosophy, and science and includes reversible and irreversible treatments. It not only affords good applicability of many principles of evidence-based dentistry but also poses numerous limitations. This article describes the epidemiologic background, fundamental considerations, scrutiny of levels of evidence, limitations, guidelines, and future perspectives of evidence-based prosthodontics. Understanding these principles can aid clinicians in appropriate appraisal of the prosthodontics literature and use the best available evidence for making confident clinical decisions and optimizing patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

The micronucleus test-most widely used in vivo genotoxicity test.

PubMed

Hayashi, Makoto

2016-01-01

Genotoxicity is commonly evaluated during the chemical safety assessment together with other toxicological endpoints. The micronucleus test is always included in many genotoxic test guidelines for long time in many classes of chemicals, e.g., pharmaceutical chemicals, agricultural chemicals, food additives. Although the trend of the safety assessment of chemicals faces to animal welfare and in vitro systems are more welcome than the in vivo systems, the in vivo test systems are paid more attention in the field of genotoxicity because of its weight of evidence. In this review, I will summarize the following points: 1) historical consideration of the test development, 2) characteristics of the test including advantages and limitations, 3) new approaches considering to the animal welfare.

Mental health and abortion: review and analysis.

PubMed

Ney, P G; Wickett, A R

1989-11-01

This survey of studies which relate to the emotional sequelae of induced abortion, draws attention to the need for more long-term, in-depth prospective studies. The literature to this point finds no psychiatric indications for abortion, and no satisfactory evidence that abortion improves the psychological state of those not mentally ill; abortion is contra-indicated when psychiatric disease is present, as mental ill-health has been shown to be worsened by abortion. Recent studies are turning up an alarming rate of post-abortion complications such as P.I.D., and subsequent infertility. The emotional impact of these complications needs to be studied. Other considerations looked at are the long-term demographic implications of abortion on demand and the effect on the medical professions.

Diagnosis of latent forms of labyrinthine affections

NASA Technical Reports Server (NTRS)

Vaslilyeva, V. P.

1980-01-01

Features and significance of individual vestibular symptoms for the diagnosis of latent labyrinthitis and limited forms of labyrinthine affections offering considerable difficulties are discussed. Vestibular symptoms are indistinct. In case of the negative fistular symptom the greatest significance is acquired by the study of posture nystagmus according to the results of electronystagmograms, changes of tonic reactions and statics, as well as data of experimental vestibular tests. The necessity of evaluation of all the vestibular symptoms from the point of view of their vector characteristics and in a complex of evidence obtained by otoneurological examination of the patient is emphasized. Delicate topic and differential diagnosis of vestibular disturbances is of great importance and significance in the choice of the conservative or surgical method of treatment.

Bayesian characterization of uncertainty in species interaction strengths.

PubMed

Wolf, Christopher; Novak, Mark; Gitelman, Alix I

2017-06-01

Considerable effort has been devoted to the estimation of species interaction strengths. This effort has focused primarily on statistical significance testing and obtaining point estimates of parameters that contribute to interaction strength magnitudes, leaving the characterization of uncertainty associated with those estimates unconsidered. We consider a means of characterizing the uncertainty of a generalist predator's interaction strengths by formulating an observational method for estimating a predator's prey-specific per capita attack rates as a Bayesian statistical model. This formulation permits the explicit incorporation of multiple sources of uncertainty. A key insight is the informative nature of several so-called non-informative priors that have been used in modeling the sparse data typical of predator feeding surveys. We introduce to ecology a new neutral prior and provide evidence for its superior performance. We use a case study to consider the attack rates in a New Zealand intertidal whelk predator, and we illustrate not only that Bayesian point estimates can be made to correspond with those obtained by frequentist approaches, but also that estimation uncertainty as described by 95% intervals is more useful and biologically realistic using the Bayesian method. In particular, unlike in bootstrap confidence intervals, the lower bounds of the Bayesian posterior intervals for attack rates do not include zero when a predator-prey interaction is in fact observed. We conclude that the Bayesian framework provides a straightforward, probabilistic characterization of interaction strength uncertainty, enabling future considerations of both the deterministic and stochastic drivers of interaction strength and their impact on food webs.

Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent.

PubMed

Salmon, Margaret; Landes, Megan; Hunchak, Cheryl; Paluku, Justin; Malemo Kalisya, Luc; Salmon, Christian; Muller, Mundenga Mutendi; Wachira, Benjamin; Mangan, James; Chhaganlal, Kajal; Kalanzi, Joseph; Azazh, Aklilu; Berman, Sara; Zied, El-Sayed; Lamprecht, Hein

2017-02-01

Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Cost Effectiveness of Malaria Interventions from Preelimination through Elimination: a Study in Iran

PubMed Central

Rezaei-Hemami, Mohsen; Akbari-Sari, Ali; Raiesi, Ahmad; Vatandoost, Hassan; Majdzadeh, Reza

2014-01-01

Background Malaria still is considered as a public health problem in Iran. The aim of the National Malaria Control Department is to reach the elimination by 2024. By decreasing the number of malaria cases in preelimination phase the cost effectiveness of malaria interventions decreases considerably. This study estimated the cost effectiveness of various strategies to combat malaria in preelimination and elimination phases in Iran. Methods: running costs of the interventions at each level of intervention was estimated by using evidence and expert opinions. The effect of each intervention was estimated using the documentary evidence available and expert opinions. Using a point estimate and distribution of each variable the sensitivity was evaluated with the Monte Carlo method. Results: The most cost-effective interventions were insecticide treated net (ITN), larviciding, surveillance for diagnosis and treatment of patients less than 24 hours, and indoor residual spraying (IRS) respectively, No related evidence found for the effectiveness of the border facilities. Conclusion: This study showed that interventions in the elimination phase of malaria have low cost effectiveness in Iran like many other countries. However ITN is the most cost effective intervention among the available interventions. PMID:25629064

Longitudinal tracking of academic progress during teacher preparation.

PubMed

Corcoran, Roisin P; O'Flaherty, Joanne

2017-12-01

Given that the ultimate academic goal of many education systems in the developed world is for students to graduate from college, grades have a considerable bearing on how effective colleges are in meeting their primary objective. Prior academic performance informs predominantly the selection and retention of teacher candidates. However, there remains a dearth of evidence linking academic performance with outcomes in teacher preparation or the workplace. This study examined pre-service teachers' trajectories of academic growth during teacher preparation. The sample comprised 398 pre-service teachers - 282 (70.8%) males and 116 (29.1%) females. Academic growth was measured across eight time points over the course of 4 years. Pre-service teachers' academic growth was analysed using linear and nonlinear latent growth models. Results indicate that academic growth was quadratic and, over time, decelerated, with no evidence of the Matthew effect or the compensatory effect. There was evidence of a connection between prior academic attainment and current grades. Greater attention to academic growth during the college years, and particularly among pre-service teachers, may enable greater achievement support for students. © 2017 The Authors. British Journal of Education Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Very Massive Stars and the upper end of the IMF

NASA Astrophysics Data System (ADS)

Crowther, P.

2013-06-01

I discuss theoretical and observational evidence regarding the existence of Very Massive Stars (VMS) with initial masses significantly in excess of 100~Mo. Theoretical evidence includes consideration of the (classical) Eddington limit, while observational evidence involves efforts to interpret photometric and spectroscopic observations of the brightest stars in young, high mass clusters (R136a, Arches, NGC 3603), including new VLT/SINFONI and HST/STIS spectroscopy plus consideration of multiplicity (binaries and higher order systems).

Point-of-Sale Tobacco Marketing in Rural and Urban Ohio: Could the New Landscape of Tobacco Products Widen Inequalities?

PubMed Central

Roberts, Megan E.; Berman, Micah L.; Slater, Michael D.; Hinton, Alice; Ferketich, Amy K.

2015-01-01

Considerable research has examined how cigarette point-of-sale advertising is closely related to smoking-related disparities across communities. Yet few studies have examined marketing of alternative tobacco products (e.g., e-cigarettes). The goal of the present study was to examine external point-of-sale marketing of various tobacco products and determine its association with community-level demographics (population density, economic-disadvantage, race/ethnicity) in urban and rural regions of Ohio. During the summer of 2014, fieldworkers collected comprehensive tobacco marketing data from 199 stores in Ohio (99 in Appalachia, 100 in Columbus), including information on external features. The address of each store was geocoded to its census tract, providing information about the community in which the store was located. Results indicated that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos, and cigars were more prevalent in communities with a higher percentage of African Americans. Cigarillos advertising was more likely in high-disadvantage and urban communities. A greater variety of products were also advertised outside retailers in urban, high-disadvantage, African American communities. Findings provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets urban, economically-disadvantaged, and African American communities. There is a need for tobacco control policies that will help improve equity and reduce health disparities. PMID:26363447

Point-of-sale tobacco marketing in rural and urban Ohio: Could the new landscape of Tobacco products widen inequalities?

PubMed

Roberts, Megan E; Berman, Micah L; Slater, Michael D; Hinton, Alice; Ferketich, Amy K

2015-12-01

Considerable research has examined how cigarette point-of-sale advertising is closely related to smoking-related disparities across communities. Yet few studies have examined marketing of alternative tobacco products (e.g., e-cigarettes). The goal of the present study was to examine external point-of-sale marketing of various tobacco products and determine its association with community-level demographics (population density, economic-disadvantage, race/ethnicity) in urban and rural regions of Ohio. During the summer of 2014, fieldworkers collected comprehensive tobacco marketing data from 199 stores in Ohio (99 in Appalachia, 100 in Columbus), including information on external features. The address of each store was geocoded to its census tract, providing information about the community in which the store was located. Results indicated that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos, and cigars were more prevalent in communities with a higher percentage of African Americans. Cigarillos advertising was more likely in high-disadvantage and urban communities. A greater variety of products were also advertised outside retailers in urban, high-disadvantage, African American communities. Findings provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets urban, economically-disadvantaged, and African American communities. There is a need for tobacco control policies that will help improve equity and reduce health disparities. Copyright © 2015 Elsevier Inc. All rights reserved.

Joint UK societies’ 2014 consensus statement on renal denervation for resistant hypertension

PubMed Central

Lobo, Melvin D; de Belder, Mark A; Cleveland, Trevor; Collier, David; Dasgupta, Indranil; Deanfield, John; Kapil, Vikas; Knight, Charles; Matson, Matthew; Moss, Jonathan; Paton, Julian F R; Poulter, Neil; Simpson, Iain; Williams, Bryan; Caulfield, Mark J

2015-01-01

Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies. PMID:25431461

Electrotherapy modalities for rotator cuff disease.

PubMed

Page, Matthew J; Green, Sally; Mrocki, Marshall A; Surace, Stephen J; Deitch, Jessica; McBain, Brodwen; Lyttle, Nicolette; Buchbinder, Rachelle

2016-06-10

Management of rotator cuff disease may include use of electrotherapy modalities (also known as electrophysical agents), which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, or thermal) into the body. Examples include therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF). These modalities are usually delivered as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. To synthesise available evidence regarding the benefits and harms of electrotherapy modalities for the treatment of people with rotator cuff disease. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCOhost, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with rotator cuff disease (e.g. subacromial impingement syndrome, rotator cuff tendinitis, calcific tendinitis), and comparing any electrotherapy modality with placebo, no intervention, a different electrotherapy modality or any other intervention (e.g. glucocorticoid injection). Trials investigating whether electrotherapy modalities were more effective than placebo or no treatment, or were an effective addition to another physical therapy intervention (e.g. manual therapy or exercise) were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. We included 47 trials (2388 participants). Most trials (n = 43) included participants with rotator cuff disease without calcification (four trials included people with calcific tendinitis). Sixteen (34%) trials investigated the effect of an electrotherapy modality delivered in isolation. Only 23% were rated at low risk of allocation bias, and 49% were rated at low risk of both performance and detection bias (for self-reported outcomes). The trials were heterogeneous in terms of population, intervention and comparator, so none of the data could be combined in a meta-analysis.In one trial (61 participants; low quality evidence), pulsed therapeutic ultrasound (three to five times a week for six weeks) was compared with placebo (inactive ultrasound therapy) for calcific tendinitis. At six weeks, the mean reduction in overall pain with placebo was -6.3 points on a 52-point scale, and -14.9 points with ultrasound (MD -8.60 points, 95% CI -13.48 to -3.72 points; absolute risk difference 17%, 7% to 26% more). Mean improvement in function with placebo was 3.7 points on a 100-point scale, and 17.8 points with ultrasound (mean difference (MD) 14.10 points, 95% confidence interval (CI) 5.39 to 22.81 points; absolute risk difference 14%, 5% to 23% more). Ninety-one per cent (29/32) of participants reported treatment success with ultrasound compared with 52% (15/29) of participants receiving placebo (risk ratio (RR) 1.75, 95% CI 1.21 to 2.53; absolute risk difference 39%, 18% to 60% more). Mean improvement in quality of life with placebo was 0.40 points on a 10-point scale, and 2.60 points with ultrasound (MD 2.20 points, 95% CI 0.91 points to 3.49 points; absolute risk difference 22%, 9% to 35% more). Between-group differences were not important at nine months. No participant reported adverse events.Therapeutic ultrasound produced no clinically important additional benefits when combined with other physical therapy interventions (eight clinically heterogeneous trials, low quality evidence). We are uncertain whether there are differences in patient-important outcomes between ultrasound and other active interventions (manual therapy, acupuncture, glucocorticoid injection, glucocorticoid injection plus oral tolmetin sodium, or exercise) because the quality of evidence is very low. Two placebo-controlled trials reported results favouring LLLT up to three weeks (low quality evidence), however combining LLLT with other physical therapy interventions produced few additional benefits (10 clinically heterogeneous trials, low quality evidence). We are uncertain whether transcutaneous electrical nerve stimulation (TENS) is more or less effective than glucocorticoid injection with respect to pain, function, global treatment success and active range of motion because of the very low quality evidence from a single trial. In other single, small trials, no clinically important benefits of pulsed electromagnetic field therapy (PEMF), microcurrent electrical stimulation (MENS), acetic acid iontophoresis and microwave diathermy were observed (low or very low quality evidence).No adverse events of therapeutic ultrasound, LLLT, TENS or microwave diathermy were reported by any participants. Adverse events were not measured in any trials investigating the effects of PEMF, MENS or acetic acid iontophoresis. Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.

20 CFR 332.7 - Consideration of evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE ACT MILEAGE OR WORK RESTRICTIONS AND STAND-BY OR LAY-OVER RULES § 332.7 Consideration of evidence... as to lay-over or stand-by status as may be necessary for the determination of his claim. An employee's statement in connection with his claim that he was not out of service because of a lay-over or...

[Theological moral considerations of advance directives].

PubMed

Virt, G

1997-01-01

The forms for advanced directives vary considerably in respect to content and wording. This article intends to develop ethical criteria for such texts, from the moraltheological point of view, also considering the social context.

Preliminary Design Considerations for Access and Operations in Earth-Moon L1/L2 Orbits

NASA Technical Reports Server (NTRS)

Folta, David C.; Pavlak, Thomas A.; Haapala, Amanda F.; Howell, Kathleen C.

2013-01-01

Within the context of manned spaceflight activities, Earth-Moon libration point orbits could support lunar surface operations and serve as staging areas for future missions to near-Earth asteroids and Mars. This investigation examines preliminary design considerations including Earth-Moon L1/L2 libration point orbit selection, transfers, and stationkeeping costs associated with maintaining a spacecraft in the vicinity of L1 or L2 for a specified duration. Existing tools in multi-body trajectory design, dynamical systems theory, and orbit maintenance are leveraged in this analysis to explore end-to-end concepts for manned missions to Earth-Moon libration points.

Effect of electromagnetic field on Kordylewski clouds formation

NASA Astrophysics Data System (ADS)

Salnikova, Tatiana; Stepanov, Sergey

2018-05-01

In previous papers the authors suggest a clarification of the phenomenon of appearance-disappearance of Kordylewski clouds - accumulation of cosmic dust mass in the vicinity of the triangle libration points of the Earth-Moon system. Under gravi-tational and light perturbation of the Sun the triangle libration points aren't the points of relative equilibrium. However, there exist the stable periodic motion of the particles, surrounding every of the triangle libration points. Due to this fact we can consider a probabilistic model of the dust clouds formation. These clouds move along the periodical orbits in small vicinity of the point of periodical orbit. To continue this research we suggest a mathematical model to investigate also the electromagnetic influences, arising under consideration of the charged dust particles in the vicinity of the triangle libration points of the Earth-Moon system. In this model we take under consideration the self-unduced force field within the set of charged particles, the probability distribution density evolves according to the Vlasov equation.

End points and assessments in esthetic dental treatment.

PubMed

Ishida, Yuichi; Fujimoto, Keiko; Higaki, Nobuaki; Goto, Takaharu; Ichikawa, Tetsuo

2015-10-01

There are two key considerations for successful esthetic dental treatments. This article systematically describes the two key considerations: the end points of esthetic dental treatments and assessments of esthetic outcomes, which are also important for acquiring clinical skill in esthetic dental treatments. The end point and assessment of esthetic dental treatment were discussed through literature reviews and clinical practices. Before designing a treatment plan, the end point of dental treatment should be established. The section entitled "End point of esthetic dental treatment" discusses treatments for maxillary anterior teeth and the restoration of facial profile with prostheses. The process of assessing treatment outcomes entitled "Assessments of esthetic dental treatment" discusses objective and subjective evaluation methods. Practitioners should reach an agreement regarding desired end points with patients through medical interviews, and continuing improvements and developments of esthetic assessments are required to raise the therapeutic level of esthetic dental treatments. Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience

PubMed Central

Thakkar, Jay; Barry, Tony; Thiagalingam, Aravinda; Redfern, Julie; McEwan, Alistair L; Rodgers, Anthony

2016-01-01

Background Mobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services. Objectives The objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs. Methods We describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME). Results The steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling. Conclusions A merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs. PMID:27847350

Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience.

PubMed

Thakkar, Jay; Barry, Tony; Thiagalingam, Aravinda; Redfern, Julie; McEwan, Alistair L; Rodgers, Anthony; Chow, Clara K

2016-11-15

Mobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services. The objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs. We describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME). The steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling. A merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs. ©Jay Thakkar, Tony Barry, Aravinda Thiagalingam, Julie Redfern, Alistair L McEwan, Anthony Rodgers, Clara K Chow. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.11.2016.

The multisystem degeneration amyotrophic lateral sclerosis - neuropathological staging and clinical translation.

PubMed

Verde, Federico; Del Tredici, Kelly; Braak, Heiko; Ludolph, Albert

2017-12-01

Amyotrophic lateral sclerosis (ALS) is traditionally considered a disease affecting exclusively motor neurons. However, much evidence points towards additional involvement of brain systems other than the motor. As much as half of ALS patients display cognitive-behavioral disturbances. ALS shares with a considerable proportion of FTD cases the same neuropathological substrate, namely, inclusions of abnormally phosphorylated protein TDP-43 (pTDP-43). In analogy with pathological staging systems elaborated in the past decades for Alzheimer's disease (AD) and Parkinson's disease (PD), a model of staging of pTDP-43 pathology in sporadic ALS (sALS) has been recently proposed. According to it, 4 stages can be recognized, where pTDP-43 inclusions are found in the agranular motor cortex and α-motor neurons of the brain stem and spinal cord (stage 1), in prefrontal neocortex (middle frontal gyrus), reticular formation, and precerebellar nuclei (stage 2), in further areas of the prefrontal neocortex (gyrus rectus and orbitofrontal gyri), postcentrally located sensory cortex, and basal ganglia (stage 3), and in the anteromedial temporal lobe including the hippocampus (stage 4). Based on this staging effort, a corticofugal axonal model for spreading of pathology can be hypothesized, whereby pathology starts in the primary motor cortex and spreads from there via axonal projections to lower motor neurons and to subcortical structures. Recent neuroradiological evidence seems to support the proposed staging system. From the clinical standpoint, a proportion of ALS patients display extramotor deficits (namely cognitive-behavioural disturbances, impaired ocular movements, and extrapyramidal alterations), which seem to correspond to the pathological involvement of the relevant cerebral structures. This review describes neuropathological sALS staging and addresses clinical evidence corresponding to this staging, pointing towards the concept of ALS as a multisystem brain degeneration disorder instead of a disease confined to motor neurons.

32 CFR 637.12 - Legal considerations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 4 2011-07-01 2011-07-01 false Legal considerations. 637.12 Section 637.12... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.12 Legal considerations. (a... of establishing a legal opinion as to whether sufficient credible evidence has been established to...

32 CFR 637.12 - Legal considerations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Legal considerations. 637.12 Section 637.12... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.12 Legal considerations. (a... of establishing a legal opinion as to whether sufficient credible evidence has been established to...

32 CFR 637.12 - Legal considerations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 4 2014-07-01 2013-07-01 true Legal considerations. 637.12 Section 637.12... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.12 Legal considerations. (a... of establishing a legal opinion as to whether sufficient credible evidence has been established to...

32 CFR 637.12 - Legal considerations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 4 2013-07-01 2013-07-01 false Legal considerations. 637.12 Section 637.12... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.12 Legal considerations. (a... of establishing a legal opinion as to whether sufficient credible evidence has been established to...

32 CFR 637.12 - Legal considerations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 4 2012-07-01 2011-07-01 true Legal considerations. 637.12 Section 637.12... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.12 Legal considerations. (a... of establishing a legal opinion as to whether sufficient credible evidence has been established to...

Helicopter simulation: An aircrew training and qualification perspective

NASA Technical Reports Server (NTRS)

Birnbach, Richard A.; Longridge, Thomas M.

1992-01-01

This paper reviews some of the unique considerations that distinguish the commercial rotary wing domain from its fixed-wing counterpart. These considerations should give the FAA cause to proceed cautiously in drawing upon its fixed-wing experience. One major point to consider is the following: device qualification should be accomplished in a context of an overall training and qualification system. This approach would take as its starting point a detailed analysis of rotary-wing missions and tasks from which proficiency objectives can be systematically developed.

Terrestrial scanning or digital images in inventory of monumental objects? - case study

NASA Astrophysics Data System (ADS)

Markiewicz, J. S.; Zawieska, D.

2014-06-01

Cultural heritage is the evidence of the past; monumental objects create the important part of the cultural heritage. Selection of a method to be applied depends on many factors, which include: the objectives of inventory, the object's volume, sumptuousness of architectural design, accessibility to the object, required terms and accuracy of works. The paper presents research and experimental works, which have been performed in the course of development of architectural documentation of elements of the external facades and interiors of the Wilanów Palace Museum in Warszawa. Point clouds, acquired from terrestrial laser scanning (Z+F 5003h) and digital images taken with Nikon D3X and Hasselblad H4D cameras were used. Advantages and disadvantages of utilisation of these technologies of measurements have been analysed with consideration of the influence of the structure and reflectance of investigated monumental surfaces on the quality of generation of photogrammetric products. The geometric quality of surfaces obtained from terrestrial laser scanning data and from point clouds resulting from digital images, have been compared.

Empowering citizens in international governance of nanotechnologies.

PubMed

Malsch, Ineke; Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Marcomini, Antonio; Mullins, Martin; Hester, Karena; McAlea, Eamonn; Murphy, Finbarr; Tofail, Syed A M

The international dialogue on responsible governance of nanotechnologies engages a wide range of actors with conflicting as well as common interests. It is also characterised by a lack of evidence-based data on uncertain risks of in particular engineered nanomaterials. The present paper aims at deepening understanding of the collective decision making context at international level using the grounded theory approach as proposed by Glaser and Strauss in "The Discovery of Grounded Theory" (1967). This starts by discussing relevant concepts from different fields including sociological and political studies of international relations as well as political philosophy and ethics. This analysis of current trends in international law making is taken as starting point for exploring the role that a software decision support tool could play in multi-stakeholder global governance of nanotechnologies. These theoretical ideas are then compared with the current design of the SUN Decision Support System (SUNDS) under development in the European project on Sustainable Nanotechnologies (SUN, www.sun-fp7.eu). Through constant comparison, the ideas are also compared with requirements of different stakeholders as expressed during a user workshop. This allows for highlighting discussion points for further consideration.

Neocortical malformation as consequence of nonadaptive regulation of neuronogenetic sequence

NASA Technical Reports Server (NTRS)

Caviness, V. S. Jr; Takahashi, T.; Nowakowski, R. S.

2000-01-01

Variations in the structure of the neocortex induced by single gene mutations may be extreme or subtle. They differ from variations in neocortical structure encountered across and within species in that these "normal" structural variations are adaptive (both structurally and behaviorally), whereas those associated with disorders of development are not. Here we propose that they also differ in principle in that they represent disruptions of molecular mechanisms that are not normally regulatory to variations in the histogenetic sequence. We propose an algorithm for the operation of the neuronogenetic sequence in relation to the overall neocortical histogenetic sequence and highlight the restriction point of the G1 phase of the cell cycle as the master regulatory control point for normal coordinate structural variation across species and importantly within species. From considerations based on the anatomic evidence from neocortical malformation in humans, we illustrate in principle how this overall sequence appears to be disrupted by molecular biological linkages operating principally outside the control mechanisms responsible for the normal structural variation of the neocortex. MRDD Research Reviews 6:22-33, 2000. Copyright 2000 Wiley-Liss, Inc.

Empowering citizens in international governance of nanotechnologies

NASA Astrophysics Data System (ADS)

Malsch, Ineke; Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Marcomini, Antonio; Mullins, Martin; Hester, Karena; McAlea, Eamonn; Murphy, Finbarr; Tofail, Syed A. M.

2015-05-01

The international dialogue on responsible governance of nanotechnologies engages a wide range of actors with conflicting as well as common interests. It is also characterised by a lack of evidence-based data on uncertain risks of in particular engineered nanomaterials. The present paper aims at deepening understanding of the collective decision making context at international level using the grounded theory approach as proposed by Glaser and Strauss in "The Discovery of Grounded Theory" (1967). This starts by discussing relevant concepts from different fields including sociological and political studies of international relations as well as political philosophy and ethics. This analysis of current trends in international law making is taken as starting point for exploring the role that a software decision support tool could play in multi-stakeholder global governance of nanotechnologies. These theoretical ideas are then compared with the current design of the SUN Decision Support System (SUNDS) under development in the European project on Sustainable Nanotechnologies (SUN, www.sun-fp7.eu). Through constant comparison, the ideas are also compared with requirements of different stakeholders as expressed during a user workshop. This allows for highlighting discussion points for further consideration.

International application of sugar-sweetened beverage (SSB) taxation in obesity reduction: factors that may influence policy effectiveness in country-specific contexts.

PubMed

Jou, Judy; Techakehakij, Win

2012-09-01

Sugar-sweetened beverage (SSB) taxation is becoming of increasing interest as a policy aimed at addressing the rising prevalence of obesity in many countries. Preliminary evidence indicates its potential to not only reduce obesity prevalence, but also generate public revenue. However, differences in country-specific contexts create uncertainties in its possible outcomes. This paper urges careful consideration of country-specific characteristics by suggesting three points in particular that may influence the effectiveness of a volume-based soft drink excise tax: population obesity prevalence, soft drink consumption levels, and existing baseline tax rates. Data from 19 countries are compared with regard to each point. The authors suggest that SSB or soft drink taxation policy may be more effective in reducing obesity prevalence where existing obesity prevalence and soft drink consumption levels are high. Conversely, in countries where the baseline tax rate is already considered high, SSB taxation may not have a noticeable impact on consumption patterns or obesity prevalence, and may incur negative feedback from the beverage industry or the general public. Thorough evaluation of these points is recommended prior to adopting SSB or soft drink taxation as an obesity reduction measure in any given country. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Robotic Observatory System Design-Specification Considerations for Achieving Long-Term Sustainable Precision Performance

NASA Astrophysics Data System (ADS)

Wray, J. D.

2003-05-01

The robotic observatory telescope must point precisely on the target object, and then track autonomously to a fraction of the FWHM of the system PSF for durations of ten to twenty minutes or more. It must retain this precision while continuing to function at rates approaching thousands of observations per night for all its years of useful life. These stringent requirements raise new challenges unique to robotic telescope systems design. Critical design considerations are driven by the applicability of the above requirements to all systems of the robotic observatory, including telescope and instrument systems, telescope-dome enclosure systems, combined electrical and electronics systems, environmental (e.g. seeing) control systems and integrated computer control software systems. Traditional telescope design considerations include the effects of differential thermal strain, elastic flexure, plastic flexure and slack or backlash with respect to focal stability, optical alignment and angular pointing and tracking precision. Robotic observatory design must holistically encapsulate these traditional considerations within the overall objective of maximized long-term sustainable precision performance. This overall objective is accomplished through combining appropriate mechanical and dynamical system characteristics with a full-time real-time telescope mount model feedback computer control system. Important design considerations include: identifying and reducing quasi-zero-backlash; increasing size to increase precision; directly encoding axis shaft rotation; pointing and tracking operation via real-time feedback between precision mount model and axis mounted encoders; use of monolithic construction whenever appropriate for sustainable mechanical integrity; accelerating dome motion to eliminate repetitive shock; ducting internal telescope air to outside dome; and the principal design criteria: maximizing elastic repeatability while minimizing slack, plastic deformation and hysteresis to facilitate long-term repeatably precise pointing and tracking performance.

Designing a mobile augmented reality tool for the locative visualisation of biomedical knowledge.

PubMed

Kilby, Jess; Gray, Kathleen; Elliott, Kristine; Waycott, Jenny; Sanchez, Fernando Martin; Dave, Bharat

2013-01-01

Mobile augmented reality (MAR) may offer new and engaging ways to support consumer participation in health. We report on design-based research into a MAR application for smartphones and tablets, intended to improve public engagement with biomedical research in a specific urban precinct. Following a review of technical capabilities and organizational and locative design considerations, we worked with staff of four research institutes to elicit their ideas about information and interaction functionalities of a shared MAR app. The results were promising, supporting the development of a prototype and initial field testing with these staff. Evidence from this project may point the way toward user-centred design of MAR services that will enable more widespread adoption of the technology in other healthcare and biomedical research contexts.

New optically stimulated luminescence ages provide evidence of MIS3 and MIS2 eolian activity on Black Mesa, northeastern Arizona, USA

USGS Publications Warehouse

Ellwein, A.L.; Mahan, S.A.; McFadden, L.D.

2011-01-01

Eolian deposition on the semiarid southern Colorado Plateau has been attributed to episodic aridity during the Quaternary Period. However, OSL ages from three topographically controlled (e.g. falling) dunes on Black Mesa in northeastern Arizona indicate that eolian sediments there were deposited in deep tributary valleys as early as 35-30. ka, with most sand deposited before 20. ka. In contrast, the oldest OSL ages for sand sheets fall within the Pleistocene-Holocene climatic transition (~. 12-8. ka). Thus most eolian sediment accumulated on Black Mesa under climatic conditions that were in general cooler, moister, and more variable than today, not more arid, pointing to a considerable increase in sediment supply. ?? 2010 University of Washington.

The controversial nuclear matrix: a balanced point of view.

PubMed

Martelli, A M; Falcieri, E; Zweyer, M; Bortul, R; Tabellini, G; Cappellini, A; Cocco, L; Manzoli, L

2002-10-01

The nuclear matrix is defined as the residual framework after the removal of the nuclear envelope, chromatin, and soluble components by sequential extractions. According to several investigators the nuclear matrix provides the structural basis for intranuclear order. However, the existence itself and the nature of this structure is still uncertain. Although the techniques used for the visualization of the nuclear matrix have improved over the years, it is still unclear to what extent the isolated nuclear matrix corresponds to an in vivo existing structure. Therefore, considerable skepticism continues to surround the nuclear matrix fraction as an accurate representation of the situation in living cells. Here, we summarize the experimental evidence in favor of, or against, the presence of a diffuse nucleoskeleton as a facilitating organizational nonchromatin structure of the nucleus.

A Point System Approach to Secondary Classroom Management

ERIC Educational Resources Information Center

Xenos, Anthony J.

2012-01-01

This article presents guiding principles governing the design, implementation, and management of a point system to promote discipline and academic rigor in a secondary classroom. Four considerations are discussed: (1) assigning appropriate point values to integral classroom behaviors and tasks; (2) determining the relationship among consequences,…

The role of evidence based medicine in neurotrauma.

PubMed

Honeybul, S; Ho, K M

2015-04-01

The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Earliest date for milk use in the Near East and southeastern Europe linked to cattle herding.

PubMed

Evershed, Richard P; Payne, Sebastian; Sherratt, Andrew G; Copley, Mark S; Coolidge, Jennifer; Urem-Kotsu, Duska; Kotsakis, Kostas; Ozdoğan, Mehmet; Ozdoğan, Aslý E; Nieuwenhuyse, Olivier; Akkermans, Peter M M G; Bailey, Douglass; Andeescu, Radian-Romus; Campbell, Stuart; Farid, Shahina; Hodder, Ian; Yalman, Nurcan; Ozbaşaran, Mihriban; Biçakci, Erhan; Garfinkel, Yossef; Levy, Thomas; Burton, Margie M

2008-09-25

The domestication of cattle, sheep and goats had already taken place in the Near East by the eighth millennium bc. Although there would have been considerable economic and nutritional gains from using these animals for their milk and other products from living animals-that is, traction and wool-the first clear evidence for these appears much later, from the late fifth and fourth millennia bc. Hence, the timing and region in which milking was first practised remain unknown. Organic residues preserved in archaeological pottery have provided direct evidence for the use of milk in the fourth millennium in Britain, and in the sixth millennium in eastern Europe, based on the delta(13)C values of the major fatty acids of milk fat. Here we apply this approach to more than 2,200 pottery vessels from sites in the Near East and southeastern Europe dating from the fifth to the seventh millennia bc. We show that milk was in use by the seventh millennium; this is the earliest direct evidence to date. Milking was particularly important in northwestern Anatolia, pointing to regional differences linked with conditions more favourable to cattle compared to other regions, where sheep and goats were relatively common and milk use less important. The latter is supported by correlations between the fat type and animal bone evidence.

Identifying Links Between Sexual Violence and Youth Violence Perpetration: New Opportunities for Sexual Violence Prevention

PubMed Central

DeGue, Sarah; Massetti, Greta M.; Holt, Melissa K.; Tharp, Andra Teten; Valle, Linda Anne; Matjasko, Jennifer L.; Lippy, Caroline

2018-01-01

Objective One promising opportunity for advancing sexual violence (SV) research and identifying new avenues for prevention involves examining other forms of violence that may share risk factors with SV. Youth violence (YV) is ideal for consideration given evidence of overlap in SV and YV risk factors, a large set of established YV risk factors across the social ecology, and the number of evidence-based YV prevention strategies available. The current paper identifies shared and unique risk factors for SV and YV and highlights evidence-based YV prevention strategies that impact these shared risk factors. Conclusions Researchers and program developers should consider adapting and evaluating evidence-based YV prevention strategies to prevent SV. Modifying these programs to address SV’s unique risk factors may maximize their potential effectiveness. In addition, expanding SV research at the outer levels of the social ecology is critical to developing community-level prevention strategies. The YV literature suggests several potential risk factors at these levels in need of research for SV, including school connectedness, social disorganization, and availability of alcohol and drugs. Using the YV literature as a starting point for expanding SV research leverages prior investments in YV research, may help identify new SV prevention strategies at a limited cost, and moves the field more quickly toward implementation of cost-effective, multidomain violence prevention strategies in communities. PMID:29644117

[Energy Conservation and Emissions Reduction Benefits Analysis for Battery Electric Buses Based on Travel Services].

PubMed

Lin, Xiao-dan; Tian, Liang; Lü, Bin; Yang, Jian-xin

2015-09-01

Battery Electric Bus (BEB) has become one of prior options of urban buses for its "zero emission" during the driving stage. However, the environmental performance of electric buses is affected by multi-factors from the point of whole life cycle. In practice, carrying capacity of BEB and power generation structures can both implement evident effects on the energy consumption and pollutants emission of BEB. Therefore, take the above factors into consideration, in this article, Life Cycle Assessment is employed to evaluate the energy conservation and emissions reduction benefits of BEB. Results indicate that, travel service is more reasonable as the functional unit, rather than mileage, since the carrying capacity of BEB is 15% lower than the diesel buses. Moreover, compared with diesel buses, the energy conservation and emissions reduction benefits of battery electric buses are all different due to different regional power structures. Specifically, the energy benefits are 7. 84%, 11. 91%, 26. 90%, 11. 15%, 19. 55% and 20. 31% respectively in Huabei, Huadong, Huazhong, Dongbei, Xibei and Nanfang power structure. From the point of comprehensive emissions reduction benefits, there is no benefit in Huabei power structure, as it depends heavily on coal. But in other areas, the comprehensive emissions reduction benefits of BEB are separately 3. 46%, 26. 81%, 1. 17%, 13. 74% and 17. 48% in Huadong, Huazhong, Dongbei, Xibei and Nanfang. Therefore, it suggests that, enlargement of carrying capacity should be taken as the most prior technology innovation direction for BEB, and the grids power structure should be taken into consideration when the development of BEB is in planning.

A Maximum Power Point Tracking Control Method of a Photovoltaic Power Generator with Consideration of Dynamic Characteristics of Solar Cells

NASA Astrophysics Data System (ADS)

Watanabe, Takashi; Yoshida, Toshiya; Ohniwa, Katsumi

This paper discusses a new control strategy for photovoltaic power generation systems with consideration of dynamic characteristics of the photovoltaic cells. The controller estimates internal currents of an equivalent circuit for the cells. This estimated, or the virtual current and the actual voltage of the cells are fed to a conventional Maximum-Power-Point-Tracking (MPPT) controller. Consequently, this MPPT controller still tracks the optimum point even though it is so designed that the seeking speed of the operating point is extremely high. This system may suit for applications, which are installed in rapidly changeable insolation and temperature-conditions e.g. automobiles, trains, and airplanes. The proposed method is verified by experiment with a combination of this estimating function and the modified Boehringer's MPPT algorithm.

Assembly of a micro-hotspot of caenogastropod endemism in the southern Nevada desert, with a description of a new species of Tryonia (Truncatelloidea, Cochliopidae).

PubMed

Hershler, Robert; Liu, Hsiu-Ping; Simpson, Jeffrey S

2015-01-01

Newly obtained and previously published sequences of the cytochrome c oxidase subunit I (COI) gene were analyzed to examine the biogeographic assembly of the caenogastropod fauna (belonging to the families Assimineidae, Cochliopidae, and Hydrobiidae) of an isolated spring along the lower Colorado River in southern Nevada (Blue Point Spring). Based on available COI clock calibrations, the three lineages that comprise this fauna are 2.78-1.42 million years old, which is roughly coeval or slightly younger than the age of Blue Point Spring (inferred from local fossil spring deposits). Two of the lineages-endemic Pyrgulopsiscoloradensis and Assimineaaff.infima-are most closely related to snails in the Death Valley area (well to the west) and likely colonized Blue Point Spring by transport on birds. A single haplotype was detected in both of these snails, suggesting that they may have only recently colonized Blue Point Spring. The third lineage-endemic Tryoniainfernalis, newly described herein based on morphological and molecular evidence-is most closely related to a geographically proximal species in a lower Colorado River tributary (Tryoniaclathrata); the split between these taxa may be the product of vicariance (severance of a prior drainage connection) or a separate jump dispersal event. The considerable genetic diversity in Tryoniainfernalis (three haplotypes differing by 0.6% mean sequence divergence) suggests a possibly lengthy history of local differentiation. Our findings also identify Blue Point Spring as a new micro-hotspot of groundwater-dependent biodiversity in Nevada and will assist ongoing efforts to protect and conserve these imperiled ecosystems.

Terrestrial laser scanning to quantify above-ground biomass of structurally complex coastal wetland vegetation

NASA Astrophysics Data System (ADS)

Owers, Christopher J.; Rogers, Kerrylee; Woodroffe, Colin D.

2018-05-01

Above-ground biomass represents a small yet significant contributor to carbon storage in coastal wetlands. Despite this, above-ground biomass is often poorly quantified, particularly in areas where vegetation structure is complex. Traditional methods for providing accurate estimates involve harvesting vegetation to develop mangrove allometric equations and quantify saltmarsh biomass in quadrats. However broad scale application of these methods may not capture structural variability in vegetation resulting in a loss of detail and estimates with considerable uncertainty. Terrestrial laser scanning (TLS) collects high resolution three-dimensional point clouds capable of providing detailed structural morphology of vegetation. This study demonstrates that TLS is a suitable non-destructive method for estimating biomass of structurally complex coastal wetland vegetation. We compare volumetric models, 3-D surface reconstruction and rasterised volume, and point cloud elevation histogram modelling techniques to estimate biomass. Our results show that current volumetric modelling approaches for estimating TLS-derived biomass are comparable to traditional mangrove allometrics and saltmarsh harvesting. However, volumetric modelling approaches oversimplify vegetation structure by under-utilising the large amount of structural information provided by the point cloud. The point cloud elevation histogram model presented in this study, as an alternative to volumetric modelling, utilises all of the information within the point cloud, as opposed to sub-sampling based on specific criteria. This method is simple but highly effective for both mangrove (r2 = 0.95) and saltmarsh (r2 > 0.92) vegetation. Our results provide evidence that application of TLS in coastal wetlands is an effective non-destructive method to accurately quantify biomass for structurally complex vegetation.

Designing Integrated Approaches to Support People with Multimorbidity: Key Messages from Systematic Reviews, Health System Leaders and Citizens.

PubMed

Wilson, Michael G; Lavis, John N; Gauvin, Francois-Pierre

2016-11-01

Living with multiple chronic conditions (multimorbidity) - and facing complex, uncoordinated and fragmented care - is part of the daily life of a growing number of Canadians. We undertook: a knowledge synthesis; a "gap analysis" of existing systematic reviews; an issue brief that synthesized the available evidence about the problem, three options for addressing it and implementation considerations; a stakeholder dialogue involving key health-system leaders; and a citizen panel. We identified several recommendations for actions that can be taken, including: developing evidence-based guidance that providers can use to help achieve goals set by patients; embracing approaches to supporting self-management; supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and investing more efforts in health promotion and disease prevention. Our results point to the need for health system decision-makers to support bottom-up, person-centred approaches to developing models of care that are tailored for people with multimorbidity and support a research agenda to address the identified priorities. Copyright © 2016 Longwoods Publishing.

Food for thought: Sub-fossil and fossil chelonian remains from Franchthi Cave and Megalopolis confirm a glacial refuge for Emys orbicularis in Peloponnesus (S. Greece)

NASA Astrophysics Data System (ADS)

Vlachos, Evangelos; Delfino, Massimo

2016-10-01

Peloponnesus peninsula (S. Greece) shows a remarkable extant chelonian fauna that has received considerable attention from a molecular and morphological point of view. Here we present new evidence from the fossil and sub-fossil record of two important sites in the area, Franchthi Cave and Megalopolis. The archaeological material from Franchthi Cave (Upper Paleolithic - Neolithic/latest Pleistocene - early Holocene) represents food remains from small game prey of the humans that inhabited the cave. The palaeontological material from Megalopolis (Late Pleistocene) comes from old and new excavations. The studied specimens, combined with information from molecular, climatic and zoological works, provide for the first time direct evidence for the presence of the European pond turtle, Emys orbicularis, in the glacial refuge of South Greece that was hypothesized on the basis of the results of molecular investigations. We also describe other chelonian taxa present in the localities, the Hermann's tortoise Testudo hermanni and the Balkan stripe-necked terrapin Mauremys rivulata, and review previously published chelonian material from Peloponnesus.

Can Winter-Active Bumblebees Survive the Cold? Assessing the Cold Tolerance of Bombus terrestris audax and the Effects of Pollen Feeding

PubMed Central

Owen, Emily L.; Bale, Jeffrey S.; Hayward, Scott A. L.

2013-01-01

There is now considerable evidence that climate change is disrupting the phenology of key pollinator species. The recently reported UK winter activity of the bumblebee Bombus terrestris brings a novel set of thermal challenges to bumblebee workers that would typically only be exposed to summer conditions. Here we assess the ability of workers to survive acute and chronic cold stress (via lower lethal temperatures and lower lethal times at 0°C), the capacity for rapid cold hardening (RCH) and the influence of diet (pollen versus nectar consumption) on supercooling points (SCP). Comparisons are made with chronic cold stress indices and SCPs in queen bumblebees. Results showed worker bees were able to survive acute temperatures likely to be experienced in a mild winter, with queens significantly more tolerant to chronic cold temperature stress. The first evidence of RCH in any Hymenoptera is shown. In addition, dietary manipulation indicated the consumption of pollen significantly increased SCP temperature. These results are discussed in the light of winter active bumblebees and climate change. PMID:24224036

Twenty years of using economic evaluations for drug reimbursement decisions: what has been achieved?

PubMed

Drummond, Michael

2013-12-01

The objective of this article is to examine the impact of economic evaluation on the reimbursement process for pharmaceuticals. The changes in the structure of reimbursement policies necessary to incorporate economic evaluation have been accomplished without major difficulty in most jurisdictions. However, several methodological differences in international guidelines for economic evaluation exist, only some of which can easily be justified. A number of beneficial changes in reimbursement processes have also been observed, such as a trend toward requiring the measurement of more meaningful clinical end points and increased engagement between manufacturers, drug regulators, and payers. A consistent finding in studies of reimbursement decisions is that economic considerations have been influential, second only to the strength of the clinical evidence for the drug of interest. The impact of economic evaluation on the allocation of health care resources is hard to ascertain because little is known about the extent to which reimbursement decisions actually lead to changes in health care practice. However, there is evidence that economic evaluation has assisted price negotiations and enabled reimbursement agencies to target drugs to those patients who will benefit the most.

A paradigm to guide health promotion into the 21st century: the integral idea whose time has come.

PubMed

Lundy, Tam

2010-09-01

The field of health promotion and education is at a turning point as it steps up to address the interconnected challenges of health, equity and sustainable development. Professionals and policy makers recognize the need for an integrative thinking and practice approach to foster comprehensive and coherent action in each of these complex areas. An integrative approach to policy and practice builds bridges across disciplines and discourses, supporting our efforts to take important next steps to generate sustainability and health for all. Comprehensive and coherent practice requires comprehensive and coherent theory. This article offers a brief introduction to Ken Wilber's influential Integral model, inviting its consideration as a promising paradigmatic framework that can guide thinking, practice, research and evidence as health promotion and education enter a new era. Currently influencing thought and practice leaders in diverse disciplines and sectors, the Integral approach presents a practical response to the current call for cross-disciplinary collaboration to address health, equity and sustainability. In addition, it addresses the disciplinary call for evidence-based practice that is grounded in, and accountable to, robust theoretical foundations.

Surgical Management of Osteoarthritis of the Knee.

PubMed

Quinn, Robert H; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

2018-05-01

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Surgical Management of Osteoarthritis of the Knee AUC clinical patient scenarios were derived from indications of patients under consideration for surgical treatment of osteoarthritis of the knee as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the three treatments. The 864 patient scenarios and 3 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Anesthesia for minimally invasive neurosurgery.

PubMed

Prabhakar, Hemanshu; Mahajan, Charu; Kapoor, Indu

2017-10-01

With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.

75 FR 3497 - Entergy Nuclear Operations, Inc., Entergy Nuclear Indian Point 2, LLC, Entergy Nuclear Indian...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-21

... NUCLEAR REGULATORY COMMISSION [Docket Nos. 50-247 and 50-286; NRC-2010-0006] Entergy Nuclear Operations, Inc., Entergy Nuclear Indian Point 2, LLC, Entergy Nuclear Indian Point 3, LLC,: Indian Point Nuclear Generating Unit Nos. 2 and 3; Notice of Consideration of Issuance of Amendment to Facility Operating License and Opportunity To Request a...

The Developmental Origins of Health and Disease and Sustainable Development Goals: mapping the way forward.

PubMed

Kajee, N; Sobngwi, E; Macnab, A; Daar, A S

2018-02-01

In this paper, meant to stimulate debate, we argue that there is considerable benefit in approaching together the implementation of two seemingly separate recent developments. First, on the global development agenda, we have the United Nations General Assembly's 2015 finalized list of 17 Sustainable Development Goals (SDGs). Several of the SDGs are related to health. Second, the field of Developmental Origins of Health and Disease (DOHaD) has garnered enough compelling evidence demonstrating that early exposures in life affect not only future health, but that the effects of that exposure can be transmitted across generations - necessitating that we begin to focus on prevention. We argue that implementing the SDGs and DOHaD together will be beneficial in several ways; and will require attending to multiple, complex and multidisciplinary approaches as we reach the point of translating science to policy to impact. Here, we begin by providing the context for our work and making the case for a mutually reinforcing, synergistic approach to implementing SDGs and DOHaD, particularly in Africa. To do this, we initiate discussion via an early mapping of some of the overlapping considerations between SDGs and DOHaD.

[Alcohol and work: ethical-deontological and medico-legal remark upon the recent set of rules].

PubMed

Chiaravalli, M; Guzzetti, Laura; Tavani, M

2007-01-01

The Disposition of the Permanent Conference for the relation among the State, the Regions and the Autonomous Provinces of Trento and Bolzano, published in Gazzetta Ufficiale n. 75 on the 30th March 2006 the list of high-risk occupations under the influence of alcohol, activating de facto a previous law (Legge n. 125, 3017 march 2001, "Legge quadro in materia di alcol e di problemi alcolcorrelati"). We here present some ethical-deontological and medical-juridical profiles on the contents of this law and some consideration about its application. Particular attention is dedicated to deontological aspects about industrial safety rules and to medico-legal aspects about occupation under the influence of alcohol, with references to complex relations among worker's discretion right, employer's right to the protection of his own interests and qualified doctor's (or someone to him comparable) right to the respect for the deontological code, with regard to benefit recipient information before the medical treatment. Authors'purpose is to evidence critical points and interpretative ambiguities of a regulation lacking in its practical applications, to provide further proposals of consideration, available to revalue a thematic rich in questions and with a significant social impact.

Rapid-Learning System for Cancer Care

PubMed Central

Abernethy, Amy P.; Etheredge, Lynn M.; Ganz, Patricia A.; Wallace, Paul; German, Robert R.; Neti, Chalapathy; Bach, Peter B.; Murphy, Sharon B.

2010-01-01

Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is “rapid-learning health care.” In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care” in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action. PMID:20585094

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016.

PubMed

Chew, Derek P; Scott, Ian A; Cullen, Louise; French, John K; Briffa, Tom G; Tideman, Philip A; Woodruffe, Stephen; Kerr, Alistair; Branagan, Maree; Aylward, Philip Eg

2016-08-01

The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations that have been graded on both the strength of evidence and the likely absolute benefit versus harm. Additional considerations influencing the delivery of specific therapies and management strategies are presented as practice points. This guideline provides advice on the standardised assessment and management of patients with suspected ACS, including the implementation of clinical assessment pathways and subsequent functional and anatomical testing. It provides guidance on the: diagnosis and risk stratification of ACS; provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction; risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS; administration of antithrombotic therapies in the acute setting and considerations affecting their long term use; and implementation of an individualised secondary prevention plan that includes both pharmacotherapies and cardiac rehabilitation. Changes in management as a result of the guideline: This guideline has been designed to facilitate the systematic integration of the recommendations into a standardised approach to ACS care, while also allowing for contextual adaptation of the recommendations in response to the individual's needs and preferences. The provision of ACS care should be subject to continuous monitoring, feedback and improvement of quality and patient outcomes.

Intervention decision-making processes and information preferences of parents of children with autism spectrum disorders.

PubMed

Grant, N; Rodger, S; Hoffmann, T

2016-01-01

When a child is diagnosed with autism, parents are faced with the task of choosing from many different intervention options. To find information about the options available, parents turn to a number of different sources. This study explores parents' (n = 23) intervention decision-making processes and information preferences following the diagnosis of ASD for their child. Qualitative thematic analysis of verbatim transcripts from interviews and focus groups involving parents of children with an autism diagnosis was undertaken. Analysis of the results revealed that there are concurrent emotional and pragmatic intervention 'journeys' undertaken by parents post diagnosis, which encompass the primary themes of: (1) information sources used, (2) parents' information preferences and (3) factors influencing intervention decision making. Parents described a journey from the point of diagnosis that involved seeking information on ASD interventions from multiple sources, with the Internet being the primary source. They were overwhelmed by the sheer volume of information available, and their preferences for information varied according to their stage in the journey post diagnosis. Parents had a 'trial and error' approach to choosing ASD interventions, with confidence increasing as they became more familiar with their child's condition, and had opportunities to explore numerous information sources about their child's diagnosis. While confidence increased over time, consideration of the effectiveness or evidence supporting interventions remained largely absent throughout the journey. This study highlights the need for parents of children with ASD to be supported to make informed intervention decisions, particularly with consideration for research evidence. © 2015 John Wiley & Sons Ltd.

Federal Facilities Programs.

ERIC Educational Resources Information Center

Chase, William W.

Brief descriptions are presented of a number of Office of Education federal funding programs directly supporting educational facilities planning and construction. Programs now in operation and several currently under consideration are pointed out. Consideration is also given to several programs in federal agencies other than the Office of…

The plasma filling factor of coronal bright points. II. Combined EIS and TRACE results

NASA Astrophysics Data System (ADS)

Dere, K. P.

2009-04-01

Aims: In a previous paper, the volumetric plasma filling factor of coronal bright points was determined from spectra obtained with the Extreme ultraviolet Imaging Spectrometer (EIS). The analysis of these data showed that the median plasma filling factor was 0.015. One interpretation of this result was that the small filling factor was consistent with a single coronal loop with a width of 1-2´´, somewhat below the apparent width. In this paper, higher spatial resolution observations with the Transition Region and Corona Explorer (TRACE) are used to test this interpretation. Methods: Rastered spectra of regions of the quiet Sun were recorded by the EIS during operations with the Hinode satellite. Many of these regions were simultaneously observed with TRACE. Calibrated intensities of Fe xii lines were obtained and images of the quiet corona were constructed from the EIS measurements. Emission measures were determined from the EIS spectra and geometrical widths of coronal bright points were obtained from the TRACE images. Electron densities were determined from density-sensitive line ratios measured with EIS. A comparison of the emission measure and bright point widths with the electron densities yielded the plasma filling factor. Results: The median electron density of coronal bright points is 3 × 109 cm-3 at a temperature of 1.6 × 106 K. The volumetric plasma filling factor of coronal bright points was found to vary from 3 × 10-3 to 0.3 with a median value of 0.04. Conclusions: The current set of EIS and TRACE coronal bright-point observations indicate the median value of their plasma filling factor is 0.04. This can be interpreted as evidence of a considerable subresolution structure in coronal bright points or as the result of a single completely filled plasma loop with widths on the order of 0.2-1.5´´ that has not been spatially resolved in these measurements.

SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. We suggest four questions that can be considered when assessing resource use and the cost consequences of an option. These are: 1. What are the most important impacts on resource use? 2. What evidence is there for important impacts on resource use? 3. How confident is it possible to be in the evidence for impacts on resource use? 4. Have the impacts on resource use been valued appropriately in terms of their true costs? PMID:20018102

Paths to Expertise in Portuguese National Team Athletes

PubMed Central

Leite, Nuno; Baker, Joseph; Sampaio, Jaime

2009-01-01

The purpose of this study was to identify the quantity and type of sporting activities undertaken by expert team sport athletes in the earlier stages of the long- term athlete development. Experts in roller-hockey (n = 19), volleyball (n = 14), soccer (n = 42) and basketball (n = 37) provided detailed information about the sporting activities they undertook throughout their careers. Results showed considerable variation between and within sports; however, generally, athletes began participating in sports between 6 and 10 years of age. The pattern of participation in specific and non-specific (team, individual and combat) sports for each stage of involvement demonstrated an increase in the number of activities participated in until early adolescence. Our results suggest that involvement in multiple sports during early stages of development is an alternative to early specialization and add further evidence of the complexity of skill acquisition in sport. Key points Although most athletes began sport participation between 6 and 10 years of age, there was significant variation across groups suggesting considerable flexibility in the pathways to expertise. The path to expertise in volleyball was clearly distinct from the paths of basketball, soccer and roller-hockey. There is a considerable involvement in sports other than the athlete’s primary sport, suggesting early specialization is not required for these sports. The pattern of participation in specific and non-specific sports for each stage of involvement demonstrated an increase in the number of activities participated in until early adolescence. PMID:24149598

Religion, politics and gender in the context of nation-state formation: the case of Serbia.

PubMed

Drezgić, Rada

2010-01-01

This article argues that nationalism has connected religion with secular politics in Serbia but that their rapprochement has been a gradual process. In order to demonstrate the transition from a limited influence of religion on politics to a much tighter relationship between the two, this article discusses the abortion legislation reform and the introduction of religious education in public schools, respectively. It argues that, while illustrative of different types of connection between religion and politics, these two issues had similar implications for gender equality-they produced discourses that recreated and justified patriarchal social norms. After religion gained access to public institutions, its (patriarchal) discourses on gender were considerably empowered. The article points to some tangible evidence of a re-traditionalisation and re-patriarchalisation of gender roles within the domestic realm in Serbia.

Atmospheres and evolution. [of microbial life on earth

NASA Technical Reports Server (NTRS)

Margulis, L.; Lovelock, J. E.

1981-01-01

Studies concerning the regulation of the earth atmosphere and the relation of atmospheric changes to the evolution of microbial life are reviewed. The improbable nature of the composition of the earth atmosphere in light of the atmospheric compositions of Mars and Venus and equilibrium considerations is pointed out, and evidence for the existence of microbial (procaryotic) life on earth as far back as 3.5 billion years ago is presented. The emergence of eucaryotic life in the Phanerozoic due to evolving symbioses between different procaryotic species is discussed with examples given of present-day symbiotic relationships between bacteria and eucaryotes. The idea that atmospheric gases are kept in balance mainly by the actions of bacterial cells is then considered, and it is argued that species diversity is necessary for the maintenance and origin of life on earth in its present form.

Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review.

PubMed

Oldenmenger, Wendy H; de Raaf, Pleun J; de Klerk, Cora; van der Rijt, Carin C D

2013-06-01

To improve the management of cancer-related symptoms, systematic screening is necessary, often performed by using 0-10 numeric rating scales. Cut points are used to determine if scores represent clinically relevant burden. The aim of this systematic review was to explore the evidence on cut points for the symptoms of the Edmonton Symptom Assessment Scale. Relevant literature was searched in PubMed, CINAHL®, Embase, and PsycINFO®. We defined a cut point as the lower bound of the scores representing moderate or severe burden. Eighteen articles were eligible for this review. Cut points were determined using the interference with daily life, another symptom-related method, or a verbal scale. For pain, cut point 5 and, to a lesser extent, cut point 7 were found as the optimal cut points for moderate pain and severe pain, respectively. For moderate tiredness, the best cut point seemed to be cut point 4. For severe tiredness, both cut points 7 and 8 were suggested frequently. A lack of evidence exists for nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. Few studies suggested a cut point below 4. For many symptoms, there is no clear evidence as to what the optimal cut points are. In daily clinical practice, a symptom score ≥4 is recommended as a trigger for a more comprehensive symptom assessment. Until there is more evidence on the optimal cut points, we should hold back using a certain cut point in quality indicators and be cautious about strongly recommending a certain cut point in guidelines. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

PubMed Central

Burns, Aine; Moranne, Olivier; Morton, Rachael L.; Naicker, Saraladevi

2016-01-01

Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care. PMID:27510453

28 CFR 61.6 - Consideration of environmental documents in decisionmaking.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Consideration of environmental documents in decisionmaking. 61.6 Section 61.6 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED..., the Department of Justice shall: (a) Consider from the earliest possible point in the process all...

A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.

PubMed

Trinka, Eugen; Cock, Hannah; Hesdorffer, Dale; Rossetti, Andrea O; Scheffer, Ingrid E; Shinnar, Shlomo; Shorvon, Simon; Lowenstein, Daniel H

2015-10-01

The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1 ). It is a condition, which can have long-term consequences (after time point t2 ), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1 ) beyond which the seizure should be regarded as "continuous seizure activity." The second time point (t2 ) is the time of ongoing seizure activity after which there is a risk of long-term consequences. In the case of convulsive (tonic-clonic) SE, both time points (t1 at 5 min and t2 at 30 min) are based on animal experiments and clinical research. This evidence is incomplete, and there is furthermore considerable variation, so these time points should be considered as the best estimates currently available. Data are not yet available for other forms of SE, but as knowledge and understanding increase, time points can be defined for specific forms of SE based on scientific evidence and incorporated into the definition, without changing the underlying concepts. A new diagnostic classification system of SE is proposed, which will provide a framework for clinical diagnosis, investigation, and therapeutic approaches for each patient. There are four axes: (1) semiology; (2) etiology; (3) electroencephalography (EEG) correlates; and (4) age. Axis 1 (semiology) lists different forms of SE divided into those with prominent motor systems, those without prominent motor systems, and currently indeterminate conditions (such as acute confusional states with epileptiform EEG patterns). Axis 2 (etiology) is divided into subcategories of known and unknown causes. Axis 3 (EEG correlates) adopts the latest recommendations by consensus panels to use the following descriptors for the EEG: name of pattern, morphology, location, time-related features, modulation, and effect of intervention. Finally, axis 4 divides age groups into neonatal, infancy, childhood, adolescent and adulthood, and elderly. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

20 CFR 367.6 - Consideration of evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... RECOVERY OF DEBTS OWED TO THE UNITED STATES GOVERNMENT BY ADMINISTRATIVE OFFSET § 367.6 Consideration of..., and a determination that all or a portion of such debt is past-due and legally enforceable will be...

Nature of the Diffuse Source and Its Central Point-like Source in SNR 0509–67.5

DOE Office of Scientific and Technical Information (OSTI.GOV)

Litke, Katrina C.; Chu, You-Hua; Holmes, Abigail

We examine a diffuse emission region near the center of SNR 0509−67.5 to determine its nature. Within this diffuse region we observe a point-like source that is bright in the near-IR, but is not visible in the B and V bands. We consider an emission line observed at 6766 Å and the possibilities that it is Ly α , H α , and [O ii] λ 3727. We examine the spectral energy distribution (SED) of the source, comprised of Hubble Space Telescope B , V , I , J , and H bands in addition to Spitzer /IRAC 3.6, 4.5,more » 5.8, and 8 μ m bands. The peak of the SED is consistent with a background galaxy at z ≈ 0.8 ± 0.2 and a possible Balmer jump places the galaxy at z ≈ 0.9 ± 0.3. These SED considerations support the emission line’s identification as [O ii] λ 3727. We conclude that the diffuse source in SNR 0509−67.5 is a background galaxy at z ≈ 0.82. Furthermore, we identify the point-like source superposed near the center of the galaxy as its central bulge. Finally, we find no evidence for a surviving companion star, indicating a double-degenerate origin for SNR 0509−67.5.« less

Gamma-Ray Observations of Supernova Remnants

NASA Astrophysics Data System (ADS)

Buckley, James

2000-04-01

Despite the growing evidence for shock acceleration of electrons in supernova remnants (SNR), there is still no direct evidence pointing unambiguously to SNR as sources of cosmic-ray nuclei. Observations of nonthermal synchrotron emission in the limbs of a number of shell-type SNR (SN1006, Tycho, Cas A, IC443, RCW86, and Kepler) provide convincing evidence for acceleration of electrons to energies greater than 10 TeV (Allen 1999). The CANGAROO group has now reported significant VHE gamma-ray emission from SN1006 (Tanimori et al. 1998) and RXJ1713-3946, and the HEGRA group has reported preliminary evidence for TeV emission from Cas A (Pülhofer et al. 1999); all of these measurements are consistent with the expected level of inverse-Compton emission in these objects. Following the predictions of an observable π^0-decay signal from nearby SNRs (e.g., Drury, Aharonian and Volk 1994) the discovery of >100 MeV emission from the direction of a number of SNR by the EGRET experiment (Esposito et al. 1996) and possible evidence for a π^0 component (Gaisser, Protheroe and Stanev 1996) led to some initial optimism that evidence for a SNR origin of cosmic-ray nuclei had been obtained. However, 200 GeV to 100 TeV measurements revealed no significant emission implying either a significantly steeper source spectrum than the canonical ~ E-2.1, a spectral cutoff below the knee energy in these sources, or that a re-interpretation of the EGRET results was required. I will discuss these results, as well as the considerable promise of future gamma-ray experiments to determine the sources of galactic cosmic-ray nuclei and to provide quantitative information about the acceleration mechanisms.

Bayesian networks of age estimation and classification based on dental evidence: A study on the third molar mineralization.

PubMed

Sironi, Emanuele; Pinchi, Vilma; Pradella, Francesco; Focardi, Martina; Bozza, Silvia; Taroni, Franco

2018-04-01

Not only does the Bayesian approach offer a rational and logical environment for evidence evaluation in a forensic framework, but it also allows scientists to coherently deal with uncertainty related to a collection of multiple items of evidence, due to its flexible nature. Such flexibility might come at the expense of elevated computational complexity, which can be handled by using specific probabilistic graphical tools, namely Bayesian networks. In the current work, such probabilistic tools are used for evaluating dental evidence related to the development of third molars. A set of relevant properties characterizing the graphical models are discussed and Bayesian networks are implemented to deal with the inferential process laying beyond the estimation procedure, as well as to provide age estimates. Such properties include operationality, flexibility, coherence, transparence and sensitivity. A data sample composed of Italian subjects was employed for the analysis; results were in agreement with previous studies in terms of point estimate and age classification. The influence of the prior probability elicitation in terms of Bayesian estimate and classifies was also analyzed. Findings also supported the opportunity to take into consideration multiple teeth in the evaluative procedure, since it can be shown this results in an increased robustness towards the prior probability elicitation process, as well as in more favorable outcomes from a forensic perspective. Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Should fertilization treatment start with reducing stress?

PubMed

Campagne, Daniel M

2006-07-01

In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. These techniques include hormonal stimulation, ICSI, gamete intra-Fallopian transfer (GIFT) and IVF, and their cost is, on average, considerable. There is substantial initial evidence that the psychological disposition of the parents-to-be influences their fertility and thus the outcome of fertilization techniques. Many fertility treatments include consultation with a psychologist and do try to keep the stress produced by the treatment itself to a minimum, using concurrent therapy. However, the accumulating evidence points to the need to program medical fertility treatment, bearing in mind both chronic and acute stress levels, and to treat for their reduction before commencing the (actual) fertility treatment. There is ample evidence that lower stress levels mean better female and male natural fertility, though there is as yet no conclusive experimental evidence that lower stress levels result in better fertility treatment outcome. However, first reducing stress may diminish the number of treatment cycles needed before pregnancy is obtained, may prepare the couple for an initial failure of treatment or even make the more invasive techniques unnecessary. Primary psychological treatment for trait and state stress, being a less invasive method than IVF, ICSI or GIFT, is to be applied whenever indicated. Also, treatment and therapy to reduce stress, and in so doing enhance fertility, do not provoke the ethical and religious objections raised by infertility treatments.

Mental health system funding of cognitive enhancement interventions for schizophrenia: summary and update of the New York Office of Mental Health expert panel and stakeholder meeting.

PubMed

McGurk, Susan R; Mueser, Kim T; Covell, Nancy H; Cicerone, Keith D; Drake, Robert E; Silverstein, Steven M; Medialia, Alice; Myers, Robert; Bellack, Alan S; Bell, Morris D; Essock, Susan M

2013-09-01

A growing research literature indicates that cognitive enhancement (CE) interventions for people with schizophrenia can improve cognitive functioning and may benefit psychosocial functioning (e.g., competitive employment, quality of social relationships). Debate continues regarding the strength of evidence for CE and related policy implications, such as the appropriateness of funding CE services. This paper summarizes and updates a meeting of experts and stakeholders convened in 2008 by the New York Office of Mental Health to review evidence on the impact of CE for people with schizophrenia and other serious mental illnesses, and addresses whether the evidence base for CE interventions is sufficient to warrant funding. Specific recommendations based on the extant literature are provided regarding the structure and components of CE programs that should be present in order to improve cognitive and psychosocial outcomes and therefore merit consideration of funding. These recommendations may serve as a starting point in developing standards for CE programs. Establishing evidence-based practice standards for implementing CE interventions for people with serious mental illnesses may facilitate dissemination of programs that have the greatest potential for improving individuals' functional outcomes while minimizing incremental costs associated with providing CE services. Important open questions include how the performance of CE programs should be monitored and which individuals might be expected to benefit from CE as evidenced by improved functioning in their everyday lives. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Dissecting Practical Intelligence Theory: Its Claims and Evidence.

ERIC Educational Resources Information Center

Gottfredson, Linda S.

2003-01-01

The two key theoretical propositions of "Practical Intelligence in Everyday Life" are made plausible only if one ignores considerable evidence contradicting them. The six key empirical claims rest primarily on the illusion of evidence enhanced by selective reporting of results. (SLD)

Evidence-Based Practice Point-of-Care Resources: A Quantitative Evaluation of Quality, Rigor, and Content.

PubMed

Campbell, Jared M; Umapathysivam, Kandiah; Xue, Yifan; Lockwood, Craig

2015-12-01

Clinicians and other healthcare professionals need access to summaries of evidence-based information in order to provide effective care to their patients at the point-of-care. Evidence-based practice (EBP) point-of-care resources have been developed and are available online to meet this need. This study aimed to develop a comprehensive list of available EBP point-of-care resources and evaluate their processes and policies for the development of content, in order to provide a critical analysis based upon rigor, transparency and measures of editorial quality to inform healthcare providers and promote quality improvement amongst publishers of EBP resources. A comprehensive and systematic search (Pubmed, CINAHL, and Cochrane Central) was undertaken to identify available EBP point-of-care resources, defined as "web-based medical compendia specifically designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, and evidence-based information (and possibly also guidance) to clinicians." A pair of investigators independently extracted information on general characteristics, content presentation, editorial quality, evidence-based methodology, and breadth and volume. Twenty-seven summary resources were identified, of which 22 met the predefined inclusion criteria for EBP point-of-care resources, and 20 could be accessed for description and assessment. Overall, the upper quartile of EBP point-of-care providers was assessed to be UpToDate, Nursing Reference Centre, Mosby's Nursing Consult, BMJ Best Practice, and JBI COnNECT+. The choice of which EBP point-of-care resources are suitable for an organization is a decision that depends heavily on the unique requirements of that organization and the resources it has available. However, the results presented in this study should enable healthcare providers to make that assessment in a clear, evidence-based manner, and provide a comprehensive list of the available options. © 2015 Sigma Theta Tau International.

Recommended Practice for Use of Emissive Probes in Electric Propulsion Testing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sheehan, J. P.; Raitses, Yevgeny; Hershkowitz, Noah

Here, this article provides recommended methods for building, operating, and taking plasma potential measurements from electron-emitting probes in electric propulsion devices, including Hall thrusters, gridded ion engines, and others. The two major techniques, the floating point technique and the inflection point technique, are described in detail as well as calibration and error-reduction methods. The major heating methods are described as well as the various considerations for emissive probe construction. Lastly, special considerations for electric propulsion plasmas are addressed, including high-energy densities, ion flows, magnetic fields, and potential fluctuations. Recommendations for probe design and operation are provided.

Recommended Practice for Use of Emissive Probes in Electric Propulsion Testing

DOE PAGES

Sheehan, J. P.; Raitses, Yevgeny; Hershkowitz, Noah; ...

2016-11-03

Here, this article provides recommended methods for building, operating, and taking plasma potential measurements from electron-emitting probes in electric propulsion devices, including Hall thrusters, gridded ion engines, and others. The two major techniques, the floating point technique and the inflection point technique, are described in detail as well as calibration and error-reduction methods. The major heating methods are described as well as the various considerations for emissive probe construction. Lastly, special considerations for electric propulsion plasmas are addressed, including high-energy densities, ion flows, magnetic fields, and potential fluctuations. Recommendations for probe design and operation are provided.

Design considerations for point-of-care clinical trials comparing methadone and buprenorphine treatment for opioid dependence in pregnancy and for neonatal abstinence syndrome.

PubMed

Winhusen, Theresa; Wilder, Christine; Wexelblatt, Scott L; Theobald, Jeffrey; Hall, Eric S; Lewis, Daniel; Van Hook, James; Marcotte, Michael

2014-09-01

In recent years, the U.S. has experienced a significant increase in the prevalence of pregnant opioid-dependent women and of neonatal abstinence syndrome (NAS), which is caused by withdrawal from in-utero drug exposure. While methadone-maintenance currently is the standard of care for opioid dependence during pregnancy, research suggests that buprenorphine-maintenance may be associated with shorter infant hospital lengths of stay (LOS) relative to methadone-maintenance. There is no "gold standard" treatment for NAS but there is evidence that buprenorphine, relative to morphine or methadone, treatment may reduce LOS and length of treatment. Point-of-care clinical trial (POCCT) designs, maximizing external validity while reducing cost and complexity associated with classic randomized clinical trials, were selected for two planned trials to compare methadone to buprenorphine treatment for opioid dependence during pregnancy and for NAS. This paper describes design considerations for the Medication-assisted treatment for Opioid-dependent expecting Mothers (MOMs; estimated N = 370) and Investigation of Narcotics for Ameliorating Neonatal abstinence syndrome on Time in hospital (INFANTs; estimated N = 284) POCCTs, both of which are randomized, intent-to-treat, two-group trials. Outcomes would be obtained from participants' electronic health record at three participating hospitals. Additionally, a subset of infants in the INFANTs POCCT would be from mothers in the MOMs POCCT and, thus, potential interaction between medication treatment of mother and infant could be evaluated. This pair of planned POCCTs would evaluate the comparative effectiveness of treatments for opioid dependence during pregnancy and for NAS. The results could have a significant impact on practice. Copyright © 2014 Elsevier Inc. All rights reserved.

A Review of Online Evidence-based Practice Point-of-Care Information Summary Providers

PubMed Central

Liberati, Alessandro; Moschetti, Ivan; Tagliabue, Ludovica; Moja, Lorenzo

2010-01-01

Background Busy clinicians need easy access to evidence-based information to inform their clinical practice. Publishers and organizations have designed specific tools to meet doctors’ needs at the point of care. Objective The aim of this study was to describe online point-of-care summaries and evaluate their breadth, content development, and editorial policy against their claims of being “evidence-based.” Methods We searched Medline, Google, librarian association websites, and information conference proceedings from January to December 2008. We included English Web-based point-of-care summaries designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, evidence-based information to clinicians. Two investigators independently extracted data on the general characteristics and content presentation of summaries. We assessed and ranked point-of-care products according to: (1) coverage (volume) of medical conditions, (2) editorial quality, and (3) evidence-based methodology. We explored how these factors were associated. Results We retrieved 30 eligible summaries. Of these products, 18 met our inclusion criteria and were qualitatively described, and 16 provided sufficient data for quantitative evaluation. The median volume of medical conditions covered was 80.6% (interquartile range, 68.9% - 84.2%) and varied for the different products. Similarly, differences emerged for editorial policy (median 8.0, interquartile range 5.8 - 10.3) and evidence-based methodology scores (median 10.0, interquartile range 1.0 - 12.8) on a 15-point scale. None of these dimensions turned out to be significantly associated with the other dimensions (editorial quality and volume, Spearman rank correlation r = -0.001, P = .99; evidence-based methodology and volume, r = -0.19, P = .48; editorial and evidence-based methodology, r = 0.43, P =.09). Conclusions Publishers are moving to develop point-of-care summary products. Some of these have better profiles than others, and there is room for improved reporting of the strengths and weaknesses of these products. PMID:20610379

Targeting STATs for cancer therapy: "Undruggable" no more.

PubMed

Frank, David A

2012-10-01

We are in the midst of an exciting transition in the treatment of cancers, from the empirically developed non-specifically cytotoxic drugs to the era of rationally derived molecularly targeted therapies. Over the past 15 years, our understanding of the mutations that drive cancer pathogenesis has grown enormously, which has rapidly led to the development of drugs to target the associated gene products. Almost all of this focus has been on kinases, largely tyrosine kinases that are activated by translocations, point mutations, insertions and deletions. Although this approach will continue to bear fruit for some time, there is increasing evidence that the returns will be diminishing. First, dominant activating mutations in kinases are less frequent then initially expected particularly in common human cancers, and thus the number of patient whose tumors have suitable targets may be limited. The second cause for concern is the rapid development of resistance that often occurs, arising either from mutations in the target kinase or activation of a parallel pathway. Thus, the desire to target a common convergence point of multiple pathways that directly contributes to the oncogenic phenotype is highly desirable. This goal has led to consideration of transcription factors as therapeutic targets.

Field demonstration of foam injection to confine a chlorinated solvent source zone.

PubMed

Portois, Clément; Essouayed, Elyess; Annable, Michael D; Guiserix, Nathalie; Joubert, Antoine; Atteia, Olivier

2018-05-01

A novel approach using foam to manage hazardous waste was successfully demonstrated under active site conditions. The purpose of the foam was to divert groundwater flow, that would normally enter the source zone area, to reduce dissolved contaminant release to the aquifer. During the demonstration, foam was pre generated and directly injected surrounding the chlorinated solvent source zone. Despite the constraints related to the industrial activities and non-optimal position of the injection points, the applicability and effectiveness of the approach have been highlighted using multiple metrics. A combination of measurements and modelling allowed definition of the foam extent surrounding each injection point, and this appears to be the critical metric to define the success of the foam injection approach. Information on the transport of chlorinated solvents in groundwater showed a decrease of contaminant flux by a factor of 4.4 downstream of the confined area. The effective permeability reduction was maintained over a period of three months. The successful containment provides evidence for consideration of the use of foam to improve traditional flushing techniques, by increasing the targeting of contaminants by remedial agents. Copyright © 2018 Elsevier B.V. All rights reserved.

New Evidence on Employment Effects of Informal Care Provision in Europe.

PubMed

Kolodziej, Ingo W K; Reichert, Arndt R; Schmitz, Hendrik

2018-02-22

To estimate how labor force participation is affected when adult children provide informal care to their parents. Survey of Health, Ageing and Retirement in Europe from 2004 to 2013. To offset the problem of endogeneity, we exploit the availability of other potential caregivers within the family as predictors of the probability to provide care for a dependent parent. Contrary to most previous studies, the dataset covers the whole working-age population in the majority of European countries. Individuals explicitly had to opt for or against the provision of care to their care-dependent parents, which allows us to more precisely estimate the effect of caregiving on labor force participation. Results reveal a negative causal effect that indicates that informal care provision reduces labor force participation by 14.0 percentage points (95 percent CI: -0.307, 0.026). Point estimates suggest that the effect is larger for men; however, this gender difference is not significantly different from zero at conventional levels. Results apply to individuals whose consideration in long-term care policy is highly relevant, that is, children whose willingness to provide informal care to their parents is altered by available alternatives of family caregivers. © Health Research and Educational Trust.

The Complex Interplay Between Cholesterol and Prostate Malignancy

PubMed Central

Solomon, Keith R.; Freeman, Michael R.

2011-01-01

Research into the topic of the role of cholesterol and prostate disease has been ongoing for many years, however our mechanistic and translational understanding is still poor. Recent evidence indicates that cholesterol lowering drugs reduce the risk of aggressive prostate cancer, however the studies in this area, performed over many years, reflect much controversy and uncertainty. Here we explore the entire literature on the relationship between circulating cholesterol and prostate cancer, with consideration and criticism of the older as well as the newer studies. We consider why low cholesterol is associated with both increased and decreased risk of advanced prostate cancer, and explain why both observations are probably correct. We discuss the conflicting results of randomized placebo-controlled trials of statin drugs vs. observational studies and demonstrate that a predominance of pravastatin in the randomized trials paints a distorted view of statin effects. Lastly, we discuss new data suggesting that a critical aspect of the role of cholesterol in prostate cancer progression is through its role in intratumoral steroidogenesis. With these points addressed, the data strongly point to hypercholesterolemia as a risk factor for prostate cancer progression and suggest clinical opportunities for the use of cholesterol lowering therapies to alter disease course. PMID:21798387

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.

PubMed

Dyson, P A; Twenefour, D; Breen, C; Duncan, A; Elvin, E; Goff, L; Hill, A; Kalsi, P; Marsland, N; McArdle, P; Mellor, D; Oliver, L; Watson, K

2018-05-01

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines. © 2018 Diabetes UK.

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness

PubMed Central

Severin, Franziska; Borry, Pascal; Cornel, Martina C; Daniels, Norman; Fellmann, Florence; Victoria Hodgson, Shirley; Howard, Heidi C; John, Jürgen; Kääriäinen, Helena; Kayserili, Hülya; Kent, Alastair; Koerber, Florian; Kristoffersson, Ulf; Kroese, Mark; Lewis, Celine; Marckmann, Georg; Meyer, Peter; Pfeufer, Arne; Schmidtke, Jörg; Skirton, Heather; Tranebjærg, Lisbeth; Rogowski, Wolf H

2015-01-01

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management. PMID:25248395

Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care- an Evidence-Based Guideline from ECCO and ESPGHAN.

PubMed

Turner, Dan; Ruemmele, Frank M; Orlanski-Meyer, Esther; Griffiths, Anne M; Carpi, Javier Martin de; Bronsky, Jiri; Veres, Gabor; Aloi, Marina; Strisciuglio, Caterina; Braegger, Christian P; Assa, Amit; Romano, Claudio; Hussey, Séamus; Stanton, Michael; Pakarinen, Mikko; de Ridder, Lissy; Katsanos, Konstantinos; Croft, Nick; Navas-López, Victor; Wilson, David C; Lawrence, Sally; Russell, Richard K

2018-05-30

The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of paediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before two face-to-face meetings. All 40 included recommendations and 86 practice points, were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate. These guidelines centre on initial use of mesalamine (including topical), before using steroids, thiopurines and, for more severe disease, anti-TNF. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision making based on clinical assessment and the paediatric UC activity index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology and transition. A brief section on disease classification using the PIBD-classes criteria and IBDU is also part of these guidelines. These guidelines provide a guide to clinicians managing children with UC and IBDU to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

PubMed

Severin, Franziska; Borry, Pascal; Cornel, Martina C; Daniels, Norman; Fellmann, Florence; Victoria Hodgson, Shirley; Howard, Heidi C; John, Jürgen; Kääriäinen, Helena; Kayserili, Hülya; Kent, Alastair; Koerber, Florian; Kristoffersson, Ulf; Kroese, Mark; Lewis, Celine; Marckmann, Georg; Meyer, Peter; Pfeufer, Arne; Schmidtke, Jörg; Skirton, Heather; Tranebjærg, Lisbeth; Rogowski, Wolf H

2015-06-01

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.

Long term variability of the annual hydrological regime and sensitivity to temperature phase shifts in Saxony/Germany

NASA Astrophysics Data System (ADS)

Renner, M.; Bernhofer, C.

2011-01-01

The timing of the seasons strongly effects ecosystems and human activities. Recently, there is increasing evidence of changes in the timing of the seasons, such as earlier spring seasons detected in phenological records, advanced seasonal timing of surface temperature, earlier snow melt or streamflow timing. For water resources management there is a need to quantitatively describe the variability in the timing of hydrological regimes and to understand how climatic changes control the seasonal water budget of river basins on the regional scale. In this study, changes of the annual cycle of hydrological variables are analysed for 27 river basins in Saxony/Germany. Thereby monthly series of basin runoff ratios, the ratio of runoff and basin precipitation are investigated for changes and variability of their annual periodicity over the period 1930-2009. Approximating the annual cycle by the means of harmonic functions gave acceptable results, while only two parameters, phase and amplitude, are required. It has been found that the annual phase of runoff ratio, representing the timing of the hydrological regime, is subject to considerable year-to-year variability, being concurrent with basins in similar hydro-climatic conditions. Two distinct basin classes have been identified, whereby basin elevation has been found to be the delimiting factor. An increasing importance of snow on the basin water balance with elevation is apparent and mainly governs the temporal variability of the annual timing of hydrological regimes. Further there is evidence of coincident changes in trend direction (change points in 1971 and 1988) in snow melt influenced basins. In these basins the timing of the runoff ratio is significantly correlated with the timing of temperature, and effects on runoff by temperature phase changes are even amplified. Interestingly, temperature effects may explain the low frequent variability of the second change point until today. However, the first change point can not be explained by temperature alone and other causes have to be considered.

Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension.

PubMed

Lobo, Melvin D; de Belder, Mark A; Cleveland, Trevor; Collier, David; Dasgupta, Indranil; Deanfield, John; Kapil, Vikas; Knight, Charles; Matson, Matthew; Moss, Jonathan; Paton, Julian F R; Poulter, Neil; Simpson, Iain; Williams, Bryan; Caulfield, Mark J

2015-01-01

Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Characterizing Heart Failure in the Ventricular Volume Domain

PubMed Central

Kerkhof, Peter LM

2015-01-01

Heart failure (HF) may be accompanied by considerable alterations of left ventricular (LV) volume, depending on the particular phenotype. Two major types of HF have been identified, although heterogeneity within each category may be considerable. All variants of HF show substantially elevated LV filling pressures, which tend to induce changes in LV size and shape. Yet, one type of HF is characterized by near-normal values for LV end-diastolic volume (EDV) and even a smaller end-systolic volume (ESV) than in matched groups of persons without cardiac disease. Furthermore, accumulating evidence indicates that, both in terms of shape and size, in men and women, the heart reacts differently to adaptive stimuli as well as to certain pharmacological interventions. Adjustments of ESV and EDV such as in HF patients are associated with (reverse) remodeling mechanisms. Therefore, it is logical to analyze HF subtypes in a graphical representation that relates ESV to EDV. Following this route, one may expect that the two major phenotypes of HF are identified as distinct entities localized in different areas of the LV volume domain. The precise coordinates of this position imply unique characteristics in terms of the actual operating point for LV volume regulation. Evidently, ejection fraction (EF; equal to 1 minus the ratio of ESV and EDV) carries little information within the LV volume representation. Thus far, classification of HF is based on information regarding EF combined with EDV. Our analysis shows that ESV in the two HF groups follows different patterns in dependency of EDV. This observation suggests that a superior HF classification system should primarily be founded on information embodied by ESV. PMID:25780344

[Effects of electroacupuncture on bispectral index and plasma beta-endorphin in patients undergoing colonoscopy].

PubMed

Ni, Yu-Fei; Li, Jun; Wang, Ben-Fu; Jiang, Song-He; Chen, Yi; Zhang, Wei-Feng; Lian, Qing-Quan

2009-10-01

To observe the effect of electroacupuncture (EA) on bispectral index (BIS) and plasma beta-endorphin (beta-EP) level in patients undergoing colonoscopy. Sixty patients were equally randomized into EA group and control group with 30 cases in each. EA (2 Hz/100 Hz, 4-6 V) was applied to the right Zusanli (ST 36) and Shangjuxu (ST 37), and the left Yinlingquan (SP 9), Sanyinjiao (SP 6) and bilateral Hegu (LI 4) respectively 30 min before colonoscopy. The mean arterial pressure (MAP), heart rate (HR) and BIS in two groups were continuously monitored during the study. Plasma beta-EP concentration was detected by radioimmunoassay. The patient's adverse reactions (including pain, satisfaction degree, etc.) were evaluated by visual analog scale (VAS) and verbal stress scale (VSS). Self-comparison showed that MAP and HR in control group increased significantly during colonoscope's splenic flexure passing (P<0.05). Whereas the 2 indexes in EA group had no significant changes during colonoscope insertion, and its splenic flexure passing, hepatic flexure passing and post-enteroscopy (P>0.05). Comparison between two groups showed that MAP at the time-point of colonoscope insertion, and HR at the time-point of colonoscope's splenic flexure passing in EA group were significantly lower than those in control group (P<0.05). BIS values of EA group were significantly lower than those of control group at different time-points after colonoscope insertion (P<0.01). Plasma beta-EP concentrations at the time-points of colonoscope's hepatic flexure passing and post-enteroscopy were evidently increased in both groups in comparison with pre-enteroscopy (P<0.01), and beta-EP was significantly lower in EA group than that in control group at the time-point of colonoscope's hepatic flexure passing (P<0.05). The dosage of Midazolam used for conscious-sedation and the scores of VAS and VSS were also considerably lower in EA group than those in control group (P<0.05, P<0.01). No significant differences were found between two groups in the adverse reactions as dizziness, nausea, vomiting and abdominal pain, but the patients' satisfaction degree in EA group was evidently higher than that in control group (P<0.05). Acupuncture analgesia can effectively lower the colonoscopy patients' BIS value and plasma beta-EP level, meaning attenuation of the patients' stress responses during colonoscopy after EA.

Dopamine modulation of emotional processing in cortical and subcortical neural circuits: evidence for a final common pathway in schizophrenia?

PubMed

Laviolette, Steven R

2007-07-01

The neural regulation of emotional perception, learning, and memory is essential for normal behavioral and cognitive functioning. Many of the symptoms displayed by individuals with schizophrenia may arise from fundamental disturbances in the ability to accurately process emotionally salient sensory information. The neurotransmitter dopamine (DA) and its ability to modulate neural regions involved in emotional learning, perception, and memory formation has received considerable research attention as a potential final common pathway to account for the aberrant emotional regulation and psychosis present in the schizophrenic syndrome. Evidence from both human neuroimaging studies and animal-based research using neurodevelopmental, behavioral, and electrophysiological techniques have implicated the mesocorticolimbic DA circuit as a crucial system for the encoding and expression of emotionally salient learning and memory formation. While many theories have examined the cortical-subcortical interactions between prefrontal cortical regions and subcortical DA substrates, many questions remain as to how DA may control emotional perception and learning and how disturbances linked to DA abnormalities may underlie the disturbed emotional processing in schizophrenia. Beyond the mesolimbic DA system, increasing evidence points to the amygdala-prefrontal cortical circuit as an important processor of emotionally salient information and how neurodevelopmental perturbances within this circuitry may lead to dysregulation of DAergic modulation of emotional processing and learning along this cortical-subcortical emotional processing circuit.

The status of health librarianship and libraries in the Republic of Ireland (SHELLI): a mixed methods review to inform future strategy and sustainability.

PubMed

Harrison, Janet; Creaser, Claire; Greenwood, Helen

2013-06-01

This paper summarises the main points of a review of the Status of Health Librarianship & Libraries in Ireland (SHELLI). The review was commissioned to gain a broad understanding of what was happening in practice in Ireland; acquire knowledge about international best practice, and to inform strategic plans to develop and sustain health libraries and librarianship in Ireland. A Mixed Methods approach was used: a literature review; an online survey distributed to health librarians; Semi structured interviews with key stakeholders; a focus group drawing participants from the survey. All evidence was triangulated. New roles for health librarians needed development and the changing educational needs of health librarians warranted attention. Increased collaboration across institutional boundaries needed more consideration, especially in relation to access to e-resources. Marketing of library services was crucial. Irish health library standards, needed to be updated and enforced and a proper evidence base established. The literature provided a number of examples of potentially useful initiatives. A strategic plan of action was drawn up in three areas: (i) to identify champions and promote visibility of health service libraries, (ii) to establish a body of evidence and (iii) to support service development and staff mentoring. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

The use of economic evaluation for guiding the pharmaceutical reimbursement list in Thailand.

PubMed

Teerawattananon, Yot; Tritasavit, Nattha; Suchonwanich, Netnapis; Kingkaew, Pritaporn

2014-01-01

Medicines expenditure consumes a significant proportion of public health expenditure in Thailand, where Universal Health Coverage has been in place since 2002. The National List of Essential Medicines has been successfully used as a pharmaceutical benefits package for all public health plans. All patients are eligible for all medicines included in the list free of charge by law. Health economic evaluation has been employed as a tool for the development of this list, including price negotiation of medicines before inclusion, especially of high-cost medicines or medicines with high budget implications. This paper illustrates the current process, mechanisms, and impact and informs of seven success factors that have contributed to the successful use of health economic evaluation in Thailand. These include strong political commitment, development of individual and institutional capacity, participation of all relevant stakeholders, establishment of standard methodological and process guidelines, consideration of several elements in the decision-making process, using evidence as a starting point rather than a deciding factor, and strong enforcement. The lessons learned from this study are likely to be applicable to other settings committed to evidence-based decision making. Copyright © 2014. Published by Elsevier GmbH.

The deep sea is a major sink for microplastic debris

PubMed Central

Woodall, Lucy C.; Sanchez-Vidal, Anna; Canals, Miquel; Paterson, Gordon L.J.; Coppock, Rachel; Sleight, Victoria; Calafat, Antonio; Rogers, Alex D.; Narayanaswamy, Bhavani E.; Thompson, Richard C.

2014-01-01

Marine debris, mostly consisting of plastic, is a global problem, negatively impacting wildlife, tourism and shipping. However, despite the durability of plastic, and the exponential increase in its production, monitoring data show limited evidence of concomitant increasing concentrations in marine habitats. There appears to be a considerable proportion of the manufactured plastic that is unaccounted for in surveys tracking the fate of environmental plastics. Even the discovery of widespread accumulation of microscopic fragments (microplastics) in oceanic gyres and shallow water sediments is unable to explain the missing fraction. Here, we show that deep-sea sediments are a likely sink for microplastics. Microplastic, in the form of fibres, was up to four orders of magnitude more abundant (per unit volume) in deep-sea sediments from the Atlantic Ocean, Mediterranean Sea and Indian Ocean than in contaminated sea-surface waters. Our results show evidence for a large and hitherto unknown repository of microplastics. The dominance of microfibres points to a previously underreported and unsampled plastic fraction. Given the vastness of the deep sea and the prevalence of microplastics at all sites we investigated, the deep-sea floor appears to provide an answer to the question—where is all the plastic? PMID:26064573

The deep sea is a major sink for microplastic debris.

PubMed

Woodall, Lucy C; Sanchez-Vidal, Anna; Canals, Miquel; Paterson, Gordon L J; Coppock, Rachel; Sleight, Victoria; Calafat, Antonio; Rogers, Alex D; Narayanaswamy, Bhavani E; Thompson, Richard C

2014-12-01

Marine debris, mostly consisting of plastic, is a global problem, negatively impacting wildlife, tourism and shipping. However, despite the durability of plastic, and the exponential increase in its production, monitoring data show limited evidence of concomitant increasing concentrations in marine habitats. There appears to be a considerable proportion of the manufactured plastic that is unaccounted for in surveys tracking the fate of environmental plastics. Even the discovery of widespread accumulation of microscopic fragments (microplastics) in oceanic gyres and shallow water sediments is unable to explain the missing fraction. Here, we show that deep-sea sediments are a likely sink for microplastics. Microplastic, in the form of fibres, was up to four orders of magnitude more abundant (per unit volume) in deep-sea sediments from the Atlantic Ocean, Mediterranean Sea and Indian Ocean than in contaminated sea-surface waters. Our results show evidence for a large and hitherto unknown repository of microplastics. The dominance of microfibres points to a previously underreported and unsampled plastic fraction. Given the vastness of the deep sea and the prevalence of microplastics at all sites we investigated, the deep-sea floor appears to provide an answer to the question-where is all the plastic?

RBE of radiations in space and the implications for space travel.

PubMed

Edwards, A A

2001-01-01

Space travellers are irradiated with cosmic rays to a dose rate considerably higher than that received on earth. In order to make sensible judgements about space exploration, the risks to health of such radiation need to be assessed. Part of the assessment of risk is to allow for the enhanced biological effectiveness of high LET radiations with respect to others. In space the high LET radiations of concern are high energy neutrons and charged particles. At the doses and dose rates encountered in space, the important risk is the induction of cancer in the astronauts. For this biological end-point there is no direct human evidence for the relative effectiveness of these radiations. There are some data for neutrons for cancer and life-shortening in laboratory animals but these are for fission spectra neutrons, which are of lower energy than those encountered in space. There is a small amount of data for protons and high energy heavier charged particles. The remaining evidence comes from cellular experiments observing chromosome aberrations and gene mutations. From this sparse information, pragmatic choices need to be made for application to protection in space. The data are reviewed and the bases for the pragmatic choices discussed.

Economic reforms and health insurance in China.

PubMed

Du, Juan

2009-08-01

During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

The management of conflict in nutrition policy formulation: choosing growth-monitoring indicators in the context of dual burden.

PubMed

Hoey, Lesli; Pelletier, David L

2011-06-01

We argue in this paper that a shared desire to find a solution to malnutrition and agreement at a broad level concerning priority, evidence-based interventions are important but not sufficient conditions for effective policy development. This paper illustrates this point, and draws out general implications, through a detailed analysis of a case in which conflict emerged when committed nutrition policy actors began discussing the details of program design and implementation. The case involves one country's effort to select "the best" anthropometric indicator for use in its national child growth-monitoring program. In this case the interested parties approached this deceptively simple decision for different reasons, using different sources and standards of evidence and focusing their attention on opposite, but equally critical, operational considerations, while being heavily influenced by global, national, and interorganizational events and relationships. We suggest that actors seeking to translate political commitment for nutrition into effective action should recognize the technical and sociopolitical complexity of seemingly simple decisions related to intervention design and employ more systematic, intentional, and inclusive decision-making procedures. Without attention to such practical matters, the current window of opportunity to reduce malnutrition on a global scale may quickly close.

The effects of negative emotions on sensory perception: fear but not anger decreases tactile sensitivity.

PubMed

Kelley, Nicholas J; Schmeichel, Brandon J

2014-01-01

Emotions and sensory perceptions are closely intertwined. Of the five senses, sight has been by far the most extensively studied sense in emotion research. Relatively less is known about how emotions influence the other four senses. Touch is essential for nonverbal communication in both humans and other animals. The current investigation tested competing hypotheses about the effect of fear on tactile perception. One hypothesis based on evolutionary considerations predicts that fear enhances sensory perception, including tactile sensitivity. A competing hypothesis based on research on peripheral psychophysiology predicts that fear should decrease tactile sensitivity. Two experiments that induced negative emotional states and measured two-point discrimination ability at the fingertip found that fear reduces tactile sensitivity relative to anger or a neutral control condition (Studies 1 and 2). These findings did not appear to be driven by participants' naïve beliefs about the influence of emotions on touch (Study 3). The results represent the first evidence of the causal impact of emotional states on tactile sensitivity, are consistent with prior evidence for the peripheral physiological effects of fear, and offer novel empirical grounds for developing and advancing theories of emotional influences on sensory perception.

Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease.

PubMed

Targher, Giovanni; Byrne, Christopher D

2017-05-01

Non-alcoholic fatty liver disease (NAFLD) is caused by an accumulation of fat in the liver; the condition can progress over time to increase the risk of developing cirrhosis, end-stage liver disease and hepatocellular carcinoma. The prevalence of NAFLD is increasing rapidly owing to the global epidemics of obesity and type 2 diabetes mellitus (T2DM), and NAFLD has been predicted to become the most important indication for liver transplantation over the next decade. It is now increasingly clear that NAFLD not only affects the liver but can also increase the risk of developing extra-hepatic diseases, including T2DM, cardiovascular disease and chronic kidney disease (CKD), which have a considerable impact on health-care resources. Accumulating evidence indicates that NAFLD exacerbates insulin resistance, predisposes to atherogenic dyslipidaemia and releases a variety of proinflammatory factors, prothrombotic factors and profibrogenic molecules that can promote vascular and renal damage. Furthermore, communication or 'crosstalk' between affected organs or tissues in these diseases has the potential to further harm function and worsen patient outcomes, and increasing amounts of evidence point to a strong association between NAFLD and CKD. Whether a causal relationship between NAFLD and CKD exists remains to be definitively established.

The effects of negative emotions on sensory perception: fear but not anger decreases tactile sensitivity

PubMed Central

Kelley, Nicholas J.; Schmeichel, Brandon J.

2014-01-01

Emotions and sensory perceptions are closely intertwined. Of the five senses, sight has been by far the most extensively studied sense in emotion research. Relatively less is known about how emotions influence the other four senses. Touch is essential for nonverbal communication in both humans and other animals. The current investigation tested competing hypotheses about the effect of fear on tactile perception. One hypothesis based on evolutionary considerations predicts that fear enhances sensory perception, including tactile sensitivity. A competing hypothesis based on research on peripheral psychophysiology predicts that fear should decrease tactile sensitivity. Two experiments that induced negative emotional states and measured two-point discrimination ability at the fingertip found that fear reduces tactile sensitivity relative to anger or a neutral control condition (Studies 1 and 2). These findings did not appear to be driven by participants’ naïve beliefs about the influence of emotions on touch (Study 3). The results represent the first evidence of the causal impact of emotional states on tactile sensitivity, are consistent with prior evidence for the peripheral physiological effects of fear, and offer novel empirical grounds for developing and advancing theories of emotional influences on sensory perception. PMID:25202299

On the nature of motivational orientations: implications of assessed goals and gender differences for motivational goal theory.

PubMed

Alonso-Tapia, Jesús; Huertas, Juan A; Ruiz, Miguel A

2010-05-01

In a historical revision of the achievement goal construct, Elliot (2005) recognized that there is little consensus on whether the term "goal" in "achievement goal orientations" (GO) is best represented as an "aim", as an overarching orientation encompassing several "aims", or as a combination of aims and other processes -self-regulation, etc.-. Elliot pointed also that goal theory research provides evidence for different models of GO. As there were no consensus on these issues, we decided to get evidence about the nature and structure of GO, about the role of gender differences in the configuration of such structure, and about relations between GO, expectancies, volitional processes and achievement. A total of 382 university students from different faculties of two public universities of Madrid (Spain) that voluntarily accepted to fill in a questionnaire that assessed different goals, expectancies and self-regulatory processes participated in the study. Scales reliability, confirmatory factor analyses, multiple-group analyses, and correlation and regression analyses were carried out. Results support the trichotomous model of GO, the consideration of GO as a combination of aims and other psychological processes, showed some gender differences and favour the adoption of a multiple goal perspective for explaining students' motivation.

Considerations for throughfall chemistry sample-size determination

Treesearch

Pamela J. Edwards; Paul Mohai; Howard G. Halverson; David R. DeWalle

1989-01-01

Both the number of trees sampled per species and the number of sampling points under each tree are important throughfall sampling considerations. Chemical loadings obtained from an urban throughfall study were used to evaluate the relative importance of both of these sampling factors in tests for determining species' differences. Power curves for detecting...

75 FR 9616 - FPL Energy Point Beach, LLC; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

... Beach, LLC; Notice of Consideration of Issuance of Amendment to Facility Operating License, Proposed No... Commission (the Commission) is considering issuance of an amendment to Renewed Facility Operating License Nos... Operating Licenses. The correction changes ``FPLE Group Capital'' to the appropriately titled ``FPL Group...

Oak policy and management in California: Spanish origins and future considerations

Treesearch

James W. Bartolome; Lynn Huntsinger

2015-01-01

The development of goals and policies for Californian oak woodlands is reviewed; then some important considerations for future policy development are highlighted. California and Spain share long and illuminating histories of human interaction with oak woodlands. The Integrated Hardwood Range Management Program, initiated about 1985, was a focal point for Californian...

Responsible, Inclusive Innovation and the Nano-Divide.

PubMed

Schroeder, Doris; Dalton-Brown, Sally; Schrempf, Benjamin; Kaplan, David

Policy makers from around the world are trying to emulate successful innovation systems in order to support economic growth. At the same time, innovation governance systems are being put in place to ensure a better integration of stakeholder views into the research and development process. In Europe, one of the most prominent and newly emerging governance frameworks is called Responsible Research and Innovation (RRI). This article aims to substantiate the following points: (1) The concept of RRI and the concept of justice can be used to derive similar ethical positions on the nano-divide. (2) Given the ambitious policy aims of RRI (e.g. economic competitiveness enhancer), the concept may be better suited to push for ethical outcomes on access to nanotechnology and its products rather than debates based on justice issues alone. It may thus serve as a mediator concept between those who push solely for competitiveness considerations and those who push solely for justice considerations in nano-technology debates. (3) The descriptive, non-normative Systems of Innovation approaches (see below) should be linked into RRI debates to provide more evidence on whether the approach advocated to achieve responsible and ethical governance of research and innovation (R&I) can indeed deliver on competitiveness (in nano-technology and other fields).

The Challenges of Projecting the Public Health Impacts of Marijuana Legalization in Canada Comment on "Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts".

PubMed

Lake, Stephanie; Kerr, Thomas

2016-09-10

A recent editorial in this journal provides a summary of key economic, social, and public health considerations of the forthcoming legislation to legalize, regulate, and restrict access to marijuana in Canada. As our government plans to implement an evidence-based public health framework for marijuana legalization, we reflect and expand on recent discussions of the public health implications of marijuana legalization, and offer additional points of consideration. We select two commonly cited public concerns of marijuana legalization - adolescent usage and impaired driving - and discuss how the underdeveloped and equivocal body of scientific literature surrounding these issues limits the ability to predict the effects of legalization. Finally, we discuss the potential for some potential public health benefits of marijuana legalization - specifically the potential for marijuana to be used as a substitute to opioids and other risky substance use - that have to date not received adequate attention. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Defective Autophagy, Mitochondrial Clearance and Lipophagy in Niemann-Pick Type B Lymphocytes

PubMed Central

Salucci, Sara; Luchetti, Francesca; Falcieri, Elisabetta; Di Sario, Gianna; Palma, Fulvio; Papa, Stefano

2016-01-01

Niemann-Pick disease type A (NP-A) and type B (NP-B) are lysosomal storage diseases (LSDs) caused by sphingomyelin accumulation in lysosomes relying on reduced or absent acid sphingomyelinase. A considerable body of evidence suggests that lysosomal storage in many LSD impairs autophagy, resulting in the accumulation of poly-ubiquitinated proteins and dysfunctional mitochondria, ultimately leading to cell death. Here we test this hypothesis in a cellular model of Niemann-Pick disease type B, in which autophagy has never been studied. The basal autophagic pathway was first examined in order to evaluate its functionality using several autophagy-modulating substances such as rapamycin and nocodazole. We found that human NP-B B lymphocytes display considerable alteration in their autophagic vacuole accumulation and mitochondrial fragmentation, as well as mitophagy induction (for damaged mitochondria clearance). Furthermore, lipid traceability of intra and extra-cellular environments shows lipid accumulation in NP-B B lymphocytes and also reveals their peculiar trafficking/management, culminating in lipid microparticle extrusion (by lysosomal exocytosis mechanisms) or lipophagy. All of these features point to the presence of a deep autophagy/mitophagy alteration revealing autophagic stress and defective mitochondrial clearance. Hence, rapamycin might be used to regulate autophagy/mitophagy (at least in part) and to contribute to the clearance of lysosomal aberrant lipid storage. PMID:27798705

Effective Detection of Low-luminosity GEO Objects Using Population and Motion Predictions

DTIC Science & Technology

2012-01-01

more assumptions made on the time, and then tracks all the points where most fragments will be in geocentric equatorial inertial coordinates over time...population. A couple of candidate points in geocentric equatorial inertial coordinates can be selected with consideration that bright stars will not be... geocentric equatorial inertial coordinates. Third, motion of fragments passing through the specified single point in geocentric equatorial

Fault Tree Handbook

DTIC Science & Technology

1981-01-01

are applied to determine what system states (usually failed states) are possible; deductive methods are applied to determine how a given system state...Similar considerations apply to the single failures of CVA, BVB and CVB and this important additional information has been displayed in the principal...way. The point "maximum tolerable failure" corresponds to the survival point of the company building the aircraft. Above that point, only intolerable

Social network type and morale in old age.

PubMed

Litwin, H

2001-08-01

The aim of this research was to derive network types among an elderly population and to examine the relationship of network type to morale. Secondary analysis of data compiled by the Israeli Central Bureau of Statistics (n = 2,079) was employed, and network types were derived through K-means cluster analysis. Respondents' morale scores were regressed on network types, controlling for background and health variables. Five network types were derived. Respondents in diverse or friends networks reported the highest morale; those in exclusively family or restricted networks had the lowest. Multivariate regression analysis underscored that certain network types were second among the study variables in predicting respondents' morale, preceded only by disability level (Adjusted R(2) =.41). Classification of network types allows consideration of the interpersonal environments of older people in relation to outcomes of interest. The relative effects on morale of elective versus obligated social ties, evident in the current analysis, is a case in point.

Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions.

PubMed

Levy, Karen; Smith, Shanon M; Carlton, Elizabeth J

2018-06-01

Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data. A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.

Neglected chaos in international stock markets: Bayesian analysis of the joint return-volatility dynamical system

NASA Astrophysics Data System (ADS)

Tsionas, Mike G.; Michaelides, Panayotis G.

2017-09-01

We use a novel Bayesian inference procedure for the Lyapunov exponent in the dynamical system of returns and their unobserved volatility. In the dynamical system, computation of largest Lyapunov exponent by traditional methods is impossible as the stochastic nature has to be taken explicitly into account due to unobserved volatility. We apply the new techniques to daily stock return data for a group of six countries, namely USA, UK, Switzerland, Netherlands, Germany and France, from 2003 to 2014, by means of Sequential Monte Carlo for Bayesian inference. The evidence points to the direction that there is indeed noisy chaos both before and after the recent financial crisis. However, when a much simpler model is examined where the interaction between returns and volatility is not taken into consideration jointly, the hypothesis of chaotic dynamics does not receive much support by the data ("neglected chaos").

Membrane interactions of ionic liquids and imidazolium salts.

PubMed

Wang, Da; Galla, Hans-Joachim; Drücker, Patrick

2018-06-01

Room-temperature ionic liquids (RTILs) have attracted considerable attention in recent years due to their versatile properties such as negligible volatility, inflammability, high extractive selectivity and thermal stability. In general, RTILs are organic salts with a melting point below ~100 °C determined by the asymmetry of at least one of their ions. Due to their amphiphilic character, strong interactions with biological materials can be expected. However, rising attention has appeared towards their similarity and interaction with biomolecules. By employing structural modifications, the biochemical properties of RTILs can be designed to mimic lipid structures and to tune their hydrophobicity towards a lipophilic behavior. This is evident for the interaction with lipid-membranes where some of these compounds present membrane-disturbing effects or cellular toxicity. Moreover, they can form micelles or lipid-like bilayer structures by themselves. Both aspects, cellular effects and membrane-forming capacities, of a novel class of lipophilic imidazolium salts will be discussed.

Non-nutritive sweeteners: no class effect on the glycemic or appetite responses to ingested glucose

PubMed Central

Bryant, Charlotte E.; Wasse, Lucy K.; Astbury, Nerys; Nandra, Gurinder; McLaughlin, John T.

2014-01-01

There is considerable interest in whether non-nutritive sweeteners are sensed in the gastrointestinal tract to modulate appetitive or absorptive responses to ingested carbohydrate. We determined the effect of a panel of non-nutritive sweeteners, aspartame, saccharin and acesulfame-K, delivered in doses that would be consumed in normal usage. Each was given in combination with glucose, assessing their effect on glycemic responses and appetite in ten healthy human subjects. There was no additional effect of aspartame or saccharin on the blood glucose response to oral glucose at any time point, although acesulfame-K exerted a small effect. However, none had an effect on perceptions of hunger or fullness. We conclude that there is no consistent evidence that non-nutrient sweeteners, when acutely consumed with glucose in dietetically relevant doses, have a class effect in modulating blood glucose in healthy human subjects. However, acesulfame-K may require further exploration. PMID:24595225

INFRARED OBSERVATIONAL MANIFESTATIONS OF YOUNG DUSTY SUPER STAR CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martínez-González, Sergio; Tenorio-Tagle, Guillermo; Silich, Sergiy, E-mail: sergiomtz@inaoep.mx

The growing evidence pointing at core-collapse supernovae as large dust producers makes young massive stellar clusters ideal laboratories to study the evolution of dust immersed in a hot plasma. Here we address the stochastic injection of dust by supernovae, and follow its evolution due to thermal sputtering within the hot and dense plasma generated by young stellar clusters. Under these considerations, dust grains are heated by means of random collisions with gas particles which result in the appearance of  infrared spectral signatures. We present time-dependent infrared spectral energy distributions that are to be expected from young stellar clusters. Our results aremore » based on hydrodynamic calculations that account for the stochastic injection of dust by supernovae. These also consider gas and dust radiative cooling, stochastic dust temperature fluctuations, the exit of dust grains out of the cluster volume due to the cluster wind, and a time-dependent grain size distribution.« less

Vitamin D and the skin: Focus on a complex relationship: A review

PubMed Central

Mostafa, Wedad Z.; Hegazy, Rehab A.

2014-01-01

The “sunshine” vitamin is a hot topic that attracted ample attention over the past decades, specially that a considerable proportion of the worldwide population are deficient in this essential nutrient. Vitamin D was primarily acknowledged for its importance in bone formation, however; increasing evidence point to its interference with the proper function of nearly every tissue in our bodies including brain, heart, muscles, immune system and skin. Thereby its deficiency has been incriminated in a long panel of diseases including cancers, autoimmune diseases, cardiovascular and neurological disorders. Its involvement in the pathogenesis of different dermatological diseases is no exception and has been the subject of much research over the recent years. In the current review, we will throw light on this highly disputed vitamin that is creating a significant concern from a dermatological perspective. Furthermore, the consequences of its deficiency on the skin will be in focus. PMID:26644915

A cholinergic feedback circuit to regulate striatal population uncertainty and optimize reinforcement learning.

PubMed

Franklin, Nicholas T; Frank, Michael J

2015-12-25

Convergent evidence suggests that the basal ganglia support reinforcement learning by adjusting action values according to reward prediction errors. However, adaptive behavior in stochastic environments requires the consideration of uncertainty to dynamically adjust the learning rate. We consider how cholinergic tonically active interneurons (TANs) may endow the striatum with such a mechanism in computational models spanning three Marr's levels of analysis. In the neural model, TANs modulate the excitability of spiny neurons, their population response to reinforcement, and hence the effective learning rate. Long TAN pauses facilitated robustness to spurious outcomes by increasing divergence in synaptic weights between neurons coding for alternative action values, whereas short TAN pauses facilitated stochastic behavior but increased responsiveness to change-points in outcome contingencies. A feedback control system allowed TAN pauses to be dynamically modulated by uncertainty across the spiny neuron population, allowing the system to self-tune and optimize performance across stochastic environments.

Is depression an inflammatory condition? A review of available evidence.

PubMed

Hashmi, Ali Madeeh; Butt, Zeeshan; Umair, Muhammad

2013-07-01

The current review examines the relationship between depression and the inflammatory immune response. Mood disorders are a significant cause of morbidity and the etiology of depression is still not clearly understood. Many studies have shown links between inflammatory cytokines and mood disorders, including elevated level of cytokines like tumour necrosis factor-alpha (TNF alpha), Interleukins (IL-1,IL-6) and others. Raised levels of cytokines have been shown to increase depressive behaviour in animal models, while many anti-depressants reverse this behaviour alongside reducing the Central Nervous System (CNS) inflammatory response and reduction in the amounts of inflammatory cytokines. Cytokines reduce neurogenesis, Brain Derived Neurotrophic Factor (BDNF) and neuronal plasticity in the CNS, while many anti-depressants have been shown to reverse these processes. The considerations of anti-depressants as anti-inflammatory agents, and implication of other anti-inflammatory therapeutics for the treatment of depression are pointed out.

[Implementation of preventive measures recommended by the federal public health office and acceptance of advice by managers of commercial solaria--studies by the public health office of the Ammerland district].

PubMed

Dahmen, H G

1990-06-01

Commercial solaria are not always up to the standards that would be desirable from a Public Health point of view in respect of protection of users against health hazards of exposure to UV radiation, and also with regard to supervision, qualified personal advice given to users by the staff, and qualification of the staff members to give such advice. Hygiene is definitely also a problem, as is evident from bacteriological swabs made from tanning beds. However, the talks conducted by a local Public Health board in Lower Saxony (North Germany) revealed considerable open-mindedness on the part of the entrepreneurs who were quite willing to follow expert health advice and to display a poster with recommendations regarding protective measures. This was combined with a questioning procedure that has proved successful with the proprietors.

EJE Prize 2012: Obesity: from genes to behaviour.

PubMed

Farooqi, I Sadaf

2014-11-01

An increase in the consumption of highly palatable foods coupled with a reduction in the amount of voluntary exercise undertaken has contributed to the rising prevalence of obesity. However, despite the obvious environmental influences, there is considerable evidence to support a genetic component to weight gain. In some people, particularly those who are severely obese, genetic factors play a major role in the development of their obesity and associated complications. Studies into the genetic basis of obesity have yielded insights into the mechanisms involved in the regulation of weight. We now understand that weight is regulated by neural mechanisms that regulate appetite and energy expenditure and that disruption of these pathways can result in severe obesity in some patients. These studies provide a starting point for investigating patients with severe obesity and may ultimately guide the development of more rational targeted therapies. © 2014 European Society of Endocrinology.

Study of gravity and magnetic anomalies using MAGSAT data

NASA Technical Reports Server (NTRS)

Braile, L. W.; Hinze, W. J.; Vonfrese, R. R. B. (Principal Investigator)

1981-01-01

The results of modeling satellite-elevation magnetic and gravity data using the constraints imposed by near surface data and seismic evidence shows that the magnetic minimum can be accounted for by either an intracrustal lithologic variation or by an upwarp of the Curie point isotherm. The long wavelength anomalies of the NOO's-vector magnetic survey of the conterminous U.S. were contoured and processed by various frequency filters to enhance particular characteristics. A preliminary inversion of the data was completed and the anomaly field calculated at 450 km from the equivalent magnet sources to compare with the POGO satellite data. Considerable progress was made in studing the satellite magnetic data of South America and adjacent marine areas. Preliminary versions of the 1 deg free-air gravity anomaly map (20 m gal contour interval) and the high cut (lambda approximately 8 deg) filtered anomaly maps are included.

Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research

PubMed Central

Badcock, Johanna C.; Dehon, Hedwige; Larøi, Frank

2017-01-01

KEY POINTS ➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions. Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research. PMID:28736541

Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research.

PubMed

Badcock, Johanna C; Dehon, Hedwige; Larøi, Frank

2017-01-01

KEY POINTS ➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions. Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.

Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory

PubMed Central

Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

2016-01-01

Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods. PMID:26797611

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes

PubMed Central

Sutton, Patrice

2014-01-01

Background: Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years. Objectives: We sought to develop a proof of concept of the “Navigation Guide,” a systematic and transparent method of research synthesis in environmental health. Discussion: The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of “risk of bias,” and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a “moderate” quality rating to human observational studies and combining diverse evidence streams. Conclusions: The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm. Citation: Woodruff TJ, Sutton P. 2014. The Navigation Guide systematic review methodology: a rigorous and transparent method for translating environmental health science into better health outcomes. Environ Health Perspect 122:1007–1014; http://dx.doi.org/10.1289/ehp.1307175 PMID:24968373

Polycystin-2-dependent control of cardiomyocyte autophagy.

PubMed

Criollo, Alfredo; Altamirano, Francisco; Pedrozo, Zully; Schiattarella, Gabriele G; Li, Dan L; Rivera-Mejías, Pablo; Sotomayor-Flores, Cristian; Parra, Valentina; Villalobos, Elisa; Battiprolu, Pavan K; Jiang, Nan; May, Herman I; Morselli, Eugenia; Somlo, Stefan; de Smedt, Humbert; Gillette, Thomas G; Lavandero, Sergio; Hill, Joseph A

2018-05-01

Considerable evidence points to critical roles of intracellular Ca 2+ homeostasis in the modulation and control of autophagic activity. Yet, underlying molecular mechanisms remain unknown. Mutations in the gene (pkd2) encoding polycystin-2 (PC2) are associated with autosomal dominant polycystic kidney disease (ADPKD), the most common inherited nephropathy. PC2 has been associated with impaired Ca 2+ handling in cardiomyocytes and indirect evidence suggests that this protein may be involved in autophagic control. Here, we investigated the role for PC2 as an essential regulator of Ca 2+ homeostasis and autophagy. Activation of autophagic flux triggered by mTOR inhibition either pharmacologically (rapamycin) or by means of nutrient depletion was suppressed in cells depleted of PC2. Moreover, cardiomyocyte-specific PC2 knockout mice (αMhc-cre;Pkd2 F/F mice) manifested impaired autophagic flux in the setting of nutrient deprivation. Stress-induced autophagy was blunted by intracellular Ca 2+ chelation using BAPTA-AM, whereas removal of extracellular Ca 2+ had no effect, pointing to a role of intracellular Ca 2+ homeostasis in stress-induced cardiomyocyte autophagy. To determine the link between stress-induced autophagy and PC2-induced Ca 2+ mobilization, we over-expressed either wild-type PC2 (WT) or a Ca 2+ -channel deficient PC2 mutant (PC2-D509V). PC2 over-expression increased autophagic flux, whereas PC2-D509V expression did not. Importantly, autophagy induction triggered by PC2 over-expression was attenuated by BAPTA-AM, supporting a model of PC2-dependent control of autophagy through intracellular Ca 2+ . Furthermore, PC2 ablation was associated with impaired Ca 2+ handling in cardiomyocytes marked by partial depletion of sarcoplasmic reticulum Ca 2+ stores. Finally, we provide evidence that Ca 2+ -mediated autophagy elicited by PC2 is a mechanism conserved across multiple cell types. Together, this study unveils PC2 as a novel regulator of autophagy acting through control of intracellular Ca 2+ homeostasis. Copyright © 2018. Published by Elsevier Ltd.

Improved dewpoint-probe calibration

NASA Technical Reports Server (NTRS)

Stephenson, J. G.; Theodore, E. A.

1978-01-01

Relatively-simple pressure-control apparatus calibrates dewpoint probes considerably faster than conventional methods, with no loss of accuracy. Technique requires only pressure measurement at each calibration point and single absolute-humidity measurement at beginning of run. Several probes can be calibrated simultaneously and points can be checked above room temperature.

Management of work-relevant upper limb disorders: a review.

PubMed

Burton, A Kim; Kendall, Nicholas A S; Pearce, Brian G; Birrell, Lisa N; Bainbridge, L Christopher

2009-01-01

Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be on side and acting in a coordinated fashion; this requires engaging employers and workers to participate. The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift.

Infusion Nursing: An Evidence-Based Approach - Third edition Alexander Mary Infusion Nursing: An Evidence-Based Approach - Third edition 625pp Elsevier 9781416064107 1416064109 [Formula: see text].

PubMed

2010-11-03

This book considers all aspects of infusion therapy and provides a solid evidence base. Its 30 chapters are well organised into six sections covering physiological considerations, infusion therapies and nursing practice.

75 FR 78705 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

...] Medicare Program; Request for Nominations for Members for the Medicare Evidence Development & Coverage... notice announces the request for nominations for consideration for membership on the Medicare Evidence... serve on the MEDCAC. Nominees are selected based upon their individual qualifications and not as...

Floating point arithmetic in future supercomputers

NASA Technical Reports Server (NTRS)

Bailey, David H.; Barton, John T.; Simon, Horst D.; Fouts, Martin J.

1989-01-01

Considerations in the floating-point design of a supercomputer are discussed. Particular attention is given to word size, hardware support for extended precision, format, and accuracy characteristics. These issues are discussed from the perspective of the Numerical Aerodynamic Simulation Systems Division at NASA Ames. The features believed to be most important for a future supercomputer floating-point design include: (1) a 64-bit IEEE floating-point format with 11 exponent bits, 52 mantissa bits, and one sign bit and (2) hardware support for reasonably fast double-precision arithmetic.

Apparatus and method for optimal phase balancing using dynamic programming with spatial consideration

DOEpatents

Robertazzi, Thomas G.; Skiena, Steven; Wang, Kai

2017-08-08

Provided are an apparatus and method for load-balancing of a three-phase electric power distribution system having a multi-phase feeder, including obtaining topology information of the feeder identifying supply points for customer loads and feeder sections between the supply points, obtaining customer information that includes peak customer load at each of the points between each of the feeder sections, performing a phase balancing analysis, and recommending phase assignment at the customer load supply points.

Evidence-based medicine for neurosurgeons: introduction and methodology.

PubMed

Linskey, Mark E

2006-01-01

Evidence-based medicine is a tool of considerable value for medicine and neurosurgery that provides a secure base for clinical practice and practice improvement, but is not without inherent drawbacks, weaknesses and limitations. EBM finds answers to only those questions open to its techniques, and the best available evidence can be a far cry from scientific truth. With the support and backing of governmental agencies, professional medical societies, the AAMC, the ACGME, and the ABMS, EBM is likely here to stay. The fact that: (1) EBM philosophy and critical appraisal techniques have become fully integrated into the training and culture of our younger colleagues, (2) that maintenance of certification will require individuals to demonstrate personal evidence based practice based on tracking and critical analysis of personal practice outcomes as part of the performance-based learning and improvement competency, and (3) that the progressively growing national healthcare expenditures will necessitate increasing basis of reimbursement and funding based on evidence-based effectiveness and guidelines, all point to the likelihood that complete immersion of neurosurgical practice in EBM is inevitable. This article thoroughly explores the history of EBM in medicine in general and in neurosurgery in particular. Emphasis is placed on identifying the legislative and regulatory motive forces at work behind its promulgation and the role that organized medicine has taken to facilitate and foster its acceptance and implementation. An accounting of resources open to neurosurgeons, and a detailed description EBM clinical decision-making methodology is presented. Special emphasis is placed on outlining the methodology as well as the limitations of meta-analyses, randomized clinic trials, and clinical practice parameter guidelines. Commonly perceived objections, as well as substantive problems and limitations of EBM assumptions, tools, and approaches both for individual clinical practice and health policy design and implementation are explored in detail.

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease.

PubMed

Murtagh, Fliss E M; Burns, Aine; Moranne, Olivier; Morton, Rachael L; Naicker, Saraladevi

2016-10-07

Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care. Copyright © 2016 by the American Society of Nephrology.

Position sense at the human elbow joint measured by arm matching or pointing.

PubMed

Tsay, Anthony; Allen, Trevor J; Proske, Uwe

2016-10-01

Position sense at the human elbow joint has traditionally been measured in blindfolded subjects using a forearm matching task. Here we compare position errors in a matching task with errors generated when the subject uses a pointer to indicate the position of a hidden arm. Evidence from muscle vibration during forearm matching supports a role for muscle spindles in position sense. We have recently shown using vibration, as well as muscle conditioning, which takes advantage of muscle's thixotropic property, that position errors generated in a forearm pointing task were not consistent with a role by muscle spindles. In the present study we have used a form of muscle conditioning, where elbow muscles are co-contracted at the test angle, to further explore differences in position sense measured by matching and pointing. For fourteen subjects, in a matching task where the reference arm had elbow flexor and extensor muscles contracted at the test angle and the indicator arm had its flexors conditioned at 90°, matching errors lay in the direction of flexion by 6.2°. After the same conditioning of the reference arm and extension conditioning of the indicator at 0°, matching errors lay in the direction of extension (5.7°). These errors were consistent with predictions based on a role by muscle spindles in determining forearm matching outcomes. In the pointing task subjects moved a pointer to align it with the perceived position of the hidden arm. After conditioning of the reference arm as before, pointing errors all lay in a more extended direction than the actual position of the arm by 2.9°-7.3°, a distribution not consistent with a role by muscle spindles. We propose that in pointing muscle spindles do not play the major role in signalling limb position that they do in matching, but that other sources of sensory input should be given consideration, including afferents from skin and joint.

Nutraceuticals in the management of patients with statin-associated muscle symptoms, with a note on real-world experience.

PubMed

Ward, Natalie C; Pang, Jing; Ryan, Jacqueline D M; Watts, Gerald F

2018-01-01

There is considerable evidence for the role of low-density lipoprotein cholesterol (LDL-C) in the development of atherosclerotic cardiovascular disease. Although statin therapy remains the most frequency prescribed medication to reduce LDL-C and lower risk of cardiovascular disease, a considerable number of patients develop muscle-related side affects. This review summarizes recent literature supporting the role of nutraceuticals as LDL-C-lowering therapy in statin-intolerant patients, with evidence from our own clinical practices. © 2018 Wiley Periodicals, Inc.

A multiple pointing-mount control strategy for space platforms

NASA Technical Reports Server (NTRS)

Johnson, C. D.

1992-01-01

A new disturbance-adaptive control strategy for multiple pointing-mount space platforms is proposed and illustrated by consideration of a simplified 3-link dynamic model of a multiple pointing-mount space platform. Simulation results demonstrate the effectiveness of the new platform control strategy. The simulation results also reveal a system 'destabilization phenomena' that can occur if the set of individual platform-mounted experiment controllers are 'too responsive.'

Strategic Materials: A Crisis Waiting to Happen.

DTIC Science & Technology

1984-09-01

of stockpile material for economic or budgetary purposes has been specifically prohibited. At this point , it would be useful to examine 0 the contents...for the period encompassed by the emergency period. Currently, this is three years. At this o point , factors reflecting the willingness to accept...Materials Advisory Board completed a study in 1981 entitled, Considerations in Choice of Form for Materials for the National Stockpile. The report points

76 FR 72046 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... Point VA Medical Center--VA Maryland Health Care System in Perryville. As consideration for the lease... their families, and a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley... consideration under such a lease for the provision of medical care and services would result in a demonstrable...

Configuration study for a 30 GHz monolithic receive array: Technical assessment

NASA Technical Reports Server (NTRS)

Nester, W. H.; Cleaveland, B.; Edward, B.; Gotkis, S.; Hesserbacker, G.; Loh, J.; Mitchell, B.

1984-01-01

The current status of monolithic microwave integrated circuits (MMICs) in phased array feeds is discussed from the point of view of cost performance, reliability, and design considerations. Transitions to MMICs, compatible antenna radiating elements and reliability considerations are addressed. Hybrid antennas, feed array antenna technology, and offset reflectors versus phased arrays are examined.

D Reconstruction from Uav-Based Hyperspectral Images

NASA Astrophysics Data System (ADS)

Liu, L.; Xu, L.; Peng, J.

2018-04-01

Reconstructing the 3D profile from a set of UAV-based images can obtain hyperspectral information, as well as the 3D coordinate of any point on the profile. Our images are captured from the Cubert UHD185 (UHD) hyperspectral camera, which is a new type of high-speed onboard imaging spectrometer. And it can get both hyperspectral image and panchromatic image simultaneously. The panchromatic image have a higher spatial resolution than hyperspectral image, but each hyperspectral image provides considerable information on the spatial spectral distribution of the object. Thus there is an opportunity to derive a high quality 3D point cloud from panchromatic image and considerable spectral information from hyperspectral image. The purpose of this paper is to introduce our processing chain that derives a database which can provide hyperspectral information and 3D position of each point. First, We adopt a free and open-source software, Visual SFM which is based on structure from motion (SFM) algorithm, to recover 3D point cloud from panchromatic image. And then get spectral information of each point from hyperspectral image by a self-developed program written in MATLAB. The production can be used to support further research and applications.

Recommendations on the use of prescribed burning practices in grassland conservation - An evidence-based study from Hungary

NASA Astrophysics Data System (ADS)

Tóthmérész, Béla; Valkó, Orsolya; Török, Péter; Végvári, Zsolt; Deák, Balázs

2015-04-01

Fire as a natural disturbance has been present in most European grasslands. In parallel controlled use of burning was an important part of the traditional landscape management for millennia. It was used to reduce litter and suppress woody vegetation as well as to maintain open landscapes suitable for farming. Recently, human activities have a considerable impact on natural fire regimes through habitat fragmentation, cessation of traditional grassland management and climate change. Nowadays the majority of human-ignited fires are uncontrolled burnings and arson, which have serious negative impacts on human life, property and can be detrimental also from the nature conservation point of view. Despite fire was widely applied in the past and the considerable extension and frequency of current grassland fires, the impact of fire on the grassland biodiversity is still scarcely documented in Europe. The aim of our study was to gather practical knowledge and experiences from Hungary concerning the effects of fire on grasslands. To fulfil this aim we sent questionnaires to experts from Hungarian national park directorates to gather unpublished data and field observations concerning the effects of burning on grasslands. Based on the answers for the questionnaires fire regularly occur in almost every grassland types in Hungary. We found that effects of fire are habitat-specific. One hand uncontrolled burning and arson have serious detrimental impacts on many endangered species (ground-dwelling birds, such as Asio flammeus, Tringa totanus and Vanellus vanellus; or lizards, such as Ablepharus kitaibelii). On the other hand in several cases fire has a positive effect on the habitat structure and favours species of high nature conservation interest (plant species, such as Adonis volgensis, Chamaecytisus supinus and Pulsatilla grandis; butterflies, such as Euphydryas aurinia; bird species such as Circus aeruginosus and Larus cachinnans). Our results suggest that even uncontrolled burning can have positive impacts from a nature conservation point of view by supporting several endangered species, reducing accumulated litter and maintaining open landscapes. Given the fact that due to land use changes and global warming the frequency of fire events are expected to increase in the next future, it is crucial to summarize evidence-based knowledge on fire in a European level and to design prescribed burning experiments in which the effects of fire could be studied in a controlled way.

The controversy about a possible relationship between mobile phone use and cancer.

PubMed

Kundi, Michael

2009-03-01

During the last decade, mobile phone use increased to almost 100% prevalence in many countries of the world. Evidence for potential health hazards accumulated in parallel by epidemiologic investigations has raised controversies about the appropriate interpretation and the degree of bias and confounding responsible for reduced or increased risk estimates. Overall, I identified 33 epidemiologic studies in the peer-reviewed literature, most of which (25) were about brain tumors. Two groups have collected data for >or=10 years of mobile phone use: Hardell and colleagues from Sweden and the Interphone group, an international consortium from 13 countries coordinated by the International Agency for Research on Cancer. Combined odds ratios (95% confidence intervals) from these studies for glioma, acoustic neuroma, and meningioma were 1.5 (1.2-1.8); 1.3 (0.95-1.9); and 1.1 (0.8-1.4), respectively. Methodologic considerations revealed that three important conditions for epidemiologic studies to detect an increased risk are not met: a ) no evidence-based exposure metric is available; b) the observed duration of mobile phone use is generally still too low; c) no evidence-based selection of end points among the grossly different types of neoplasias is possible because of lack of etiologic hypotheses. Concerning risk estimates, selection bias, misclassification bias, and effects of the disease on mobile phone use could have reduced estimates, and recall bias may have led to spuriously increased risks. The overall evidence speaks in favor of an increased risk, but its magnitude cannot be assessed at present because of insufficient information on long-term use.

Ground-state Properties of Inhomogeneous Graphene Sheets

NASA Astrophysics Data System (ADS)

Polini, Marco

2009-03-01

When inter-valley scattering is weak and gauge fields due to e.g. ripples are neglected, doped and gated graphene sheets can be described using an envelope-function Hamiltonian with a new sublattice pseudospin degree-of freedom, an ultrarelativistic massless-Dirac free-fermion term, a pseudospin scalar disorder potential, and a non-relativistic instantaneous Coulombic interaction term. There is considerable evidence from experiment that this simplified description of a honeycomb lattice of Carbon atoms is usually a valid starting point for theories of those observables that depend solely on the electronic properties of π-electrons near the graphene Dirac point [1]. Although the use of this model simplifies the physics considerably it still leaves us with a many-body problem without translational invariance, which we do not know how to solve. In this talk we present a Kohn-Sham-Dirac density-functional-theory (DFT) scheme for graphene sheets that treats slowly-varying inhomogeneous scalar external potentials and electron-electron interactions on an equal footing [2]. The theory is able to account for the unusual property that the exchange-correlation contribution to chemical potential increases with carrier density in graphene [3,4]. Consequences of this property, and advantages and disadvantages of using the DFT approach to describe it, are discussed. The approach is illustrated by solving the Kohn-Sham-Dirac equations self-consistently for a model random potential describing charged point-like impurities located close to the graphene plane. The influence of electron-electron interactions on these non-linear screening calculations is discussed at length, in the light of recent experiments [5,6] reporting evidence for the presence of electron-hole puddles in nearly-neutral graphene sheets. [4pt] [1] A.K. Geim and K.S. Novoselov, Nature Mater. 6, 183 (2007); A.K. Geim and A.H. MacDonald, Phys. Today 60, 35 (2007); A.H. Castro Neto, F. Guinea, N.M.R. Peres, K.S. Novoselov, and A.K. Geim, arXiv:0709.1163v2 (2007).[0pt] [2] M. Polini, A. Tomadin, R. Asgari, and A.H. MacDonald, Phys. Rev. B 78, 115426 (2008).[0pt] [3] Y. Barlas, T. Pereg-Barnea, M. Polini, R. Asgari, and A.H. MacDonald, Phys. Rev. Lett. 98, 236601 (2007); M. Polini, R. Asgari, Y. Barlas, T. Pereg-Barnea, and A.H. MacDonald, Solid State Commun. 143, 58 (2007). [0pt] [4] E.H. Hwang, B.Y.-K. Hu, and S. Das Sarma, Phys. Rev. Lett. 99, 226801 (2007).[0pt] [5] J. Martin, N. Akerman, G. Ulbricht, T. Lohmann, J.H. Smet, K. von Klitzing, and A. Yacoby, Nature Phys. 4, 144 (2008).[0pt] [6] V.W. Brar, Y. Zhang, C. Girit, F. Wang, A. Zettl, and M. Crommie, Bull. Am. Phys. Soc. 53 (2), 443 (2008).

Safety considerations in the pharmacological management of atrial fibrillation.

PubMed

Camm, A John

2008-07-21

The pharmacological management of atrial fibrillation (AF) requires careful consideration from a safety perspective. This article focuses primarily on maintenance therapy using antiarrhythmic drugs (AADs). The foremost safety issue for AADs is the propensity of class IA and III agents to cause torsade de pointes arrhythmias. Class IA drugs, particularly quinidine, can induce torsade de pointes at low or subtherapeutic doses, but higher doses are not necessarily associated with an increased incidence. 'Pure' class III drugs such as dofetilide induce torsade de pointes in a dose-related manner, but some class III agents with more complex actions such as amiodarone have a markedly lower potential to cause this arrhythmia. The risk of torsade de pointes precludes the use of class IA and 'pure' class III agents in patients with left ventricular hypertrophy and bradycardia. Class IC agents may cause sustained monomorphic ventricular tachycardias and are generally precluded in ischaemic and structural heart disease. Advanced heart failure patients may be treated with amiodarone or dofetilide, but most other AADs are unsuitable. The most important extracardiac toxicities occurring with AADs are those of amiodarone. Drug interactions are a significant safety issue in the management of AF, including pharmacokinetic interactions in which plasma levels of the AAD are raised - increasing the risk of proarrhythmia - and concomitant use of drugs that prolong the QT interval. Notwithstanding these considerations, most patients with AF can be considered for rhythm control, provided there is adequate pre-treatment assessment and protocols for initiation, dosing and monitoring are followed with care.

Differences in the Weighting and Choice of Evidence for Plausible versus Implausible Causes

ERIC Educational Resources Information Center

Goedert, Kelly M.; Ellefson, Michelle R.; Rehder, Bob

2014-01-01

Individuals have difficulty changing their causal beliefs in light of contradictory evidence. We hypothesized that this difficulty arises because people facing implausible causes give greater consideration to causal alternatives, which, because of their use of a positive test strategy, leads to differential weighting of contingency evidence.…

Presenting Global Warming and Evolution as Public Health Issues to Encourage Acceptance of Scientific Evidence

ERIC Educational Resources Information Center

Stover, Shawn K.; McArthur, Laurence B.; Mabry, Michelle L.

2013-01-01

Although evidence supporting anthropogenic global warming and evolution by natural selection is considerable, the public does not embrace these concepts. The current study explores the hypothesis that individuals will become more receptive to scientific viewpoints if evidence for evolution and implications of global warming are presented as issues…

School Corporal Punishment, Family Tension, and Students' Internalizing Problems: Evidence from India

ERIC Educational Resources Information Center

Deb, Sibnath; Kumar, Aneesh; Holden, George W.; Simpson Rowe, Lorelei

2017-01-01

There is considerable evidence that parental corporal punishment (CP) is positively associated with children's behavioral and mental health problems. However, there is very little evidence addressing whether CP perpetrated by teachers or school staff is similarly associated with problematic student functioning. To address this gap in the research…

The point system for driver license administration : a viable alternative for Virginia?.

DOT National Transportation Integrated Search

1972-01-01

Traffic safety research was noted to have been unable to produce any empirical evidence that the introduction of a point system would affect, either negatively or positively, traffic accident statistics. In view of this absence of evidence, the simil...

Super-Resolution Imagery by Frequency Sweeping.

DTIC Science & Technology

1980-08-15

IMAGE RETRIEVAL The above considerations of multiwavelength holography have lead us to determining a means by which the 3-D Fourier space of the...it at a distant bright point source. The point source used need not be derived from a laser. In fact it is preferable for safety purposes to use an LED ...noise and therefore higher reconstructed image quality can be attained by using nonlaser point sources in the reconstruction such as LED or miniature

Enhancing rigor and practice of scoping reviews in social policy research: considerations from a worked example on the Americans with disabilities act.

PubMed

Harris, Sarah Parker; Gould, Robert; Fujiura, Glenn

2015-01-01

There is increasing theoretical consideration about the use of systematic and scoping reviews of evidence in informing disability and rehabilitation research and practice. Indicative of this trend, this journal published a piece by Rumrill, Fitzgerald and Merchant in 2010 explaining the utility and process for conducting reviews of intervention-based research. There is still need to consider how to apply such rigor when conducting more exploratory reviews of heterogeneous research. This article explores the challenges, benefits, and procedures for conducting rigorous exploratory scoping reviews of diverse evidence. The article expands upon Rumrill, Fitzgerald and Merchant's framework and considers its application to more heterogeneous evidence on the impact of social policy. A worked example of a scoping review of the Americans with Disabilities Act is provided with a procedural framework for conducting scoping reviews on the effects of a social policy. The need for more nuanced techniques for enhancing rigor became apparent during the review process. There are multiple methodological steps that can enhance the utility of exploratory scoping reviews. The potential of systematic consideration during the exploratory review process is shown as a viable method to enhance the rigor in reviewing diverse bodies of evidence.

Hormone Replacement Therapy and Opioid Tapering for Opioid-Induced Hypogonadism Among Patients with Chronic Noncancer Pain: A Systematic Review.

PubMed

AminiLari, Mahmood; Manjoo, Priya; Craigie, Samantha; Couban, Rachel; Wang, Li; Busse, Jason W

2018-05-02

To systematically review evidence addressing the efficacy of testosterone replacement therapy (TRT) and opioid tapering for opioid-induced hypogonadism among patients with chronic noncancer pain. Systematic review of randomized controlled trials (RCTs) and observational studies. We searched MEDLINE, CINAHL, AMED, CENTRAL, CINAHL, DARE, EMBASE, and PsycINFO through August 2017. Eligible studies enrolled ≥10 patients with chronic noncancer pain and opioid-induced hypogonadism and reported the effect of TRT or opioid tapering on a patient-important outcome collected ≥14 days after treatment. Pairs of reviewers independently screened for eligible studies, assessed risk of bias, and extracted data. We used the GRADE approach to rate quality of evidence. Of 666 abstracts reviewed, five studies including one RCT (N = 84) and four observational studies (N = 157) were eligible. No studies explored the effect of opioid tapering for opioid-induced hypogonadism. Very low-quality evidence found that TRT was associated with improvements in pain (median reduction of 2 points on the 11-point numerical rating scale for pain; 95% confidence interval [CI] = -1.4 to -2.6; minimally important difference [MID] = 2 points), and emotional functioning (mean increase of 9 points on the 100-point SF-36 Mental Component Summary score; 95% CI = 4.40 to 13.60; MID = 5 points). Low-quality evidence suggested that TRT had no effect on sleep quality, sexual function, physical functioning, role functioning, or social functioning; very low-quality evidence suggested no association with depressive symptoms. Low-quality to very low-quality evidence suggests that TRT may improve pain and emotional functioning, but not other outcomes, in chronic noncancer pain patients with opioid-induced hypogonadism.

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

PubMed

Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

2016-01-01

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Safety of transcranial Direct Current Stimulation: Evidence Based Update 2016

PubMed Central

Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R.; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H.; Hampstead, Benjamin M.; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A.; Reis, Janine; Richardson, Jessica D.; Rotenberg, Alexander; Turkeltaub, Peter E.; Woods, Adam J.

2016-01-01

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3–13 A/m2) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 mA, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1,000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. PMID:27372845

How To Modify a Trailer for Accessibility (Up to a Point) [and] Accessibility Considerations for Home Buyers. Key Notes.

ERIC Educational Resources Information Center

Access Group, Atlanta, GA.

Two brief fact sheets for people with disabilities provide information on: (1) modifying a trailer to make it accessible for persons with mobility impairments, especially those in wheelchairs, and (2) accessibility considerations for home buyers or home owners with mobility impairments. The first fact sheet identifies inherent problems in…

Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction.

PubMed

Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana K; Francis, Jane M; Dwight, Jeremy S; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael; Ashrafian, Houman

2015-11-03

Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [o2 peak] <80% predicted for age and sex). The result was compared with 22 similarly treated matched asymptomatic hypertensive volunteers. The primary end point was the change in o2 peak. Secondary outcomes included tissue Doppler-derived E/e' at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; P<0.0001) and hypertensive (127 versus 145 bpm; P=0.003) cohorts. Ivabradine compared with placebo significantly worsened the change in o2 peak in the HFpEF cohort (-2.1 versus 0.9 mL·kg(-1)·min(-1); P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354573. © 2015 The Authors.

Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.

PubMed Central

Naylor, C D; Williams, J I

1996-01-01

OBJECTIVES--To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN--Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING--Ontario, Canada. MAIN MEASURES--Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS--Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS--These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery. PMID:10157268

Unbounding the mental number line—new evidence on children's spatial representation of numbers

PubMed Central

Link, Tanja; Huber, Stefan; Nuerk, Hans-Christoph; Moeller, Korbinian

2014-01-01

Number line estimation (i.e., indicating the position of a given number on a physical line) is a standard assessment of children's spatial representation of number magnitude. Importantly, there is an ongoing debate on the question in how far the bounded task version with start and endpoint given (e.g., 0 and 100) might induce specific estimation strategies and thus may not allow for unbiased inferences on the underlying representation. Recently, a new unbounded version of the task was suggested with only the start point and a unit fixed (e.g., the distance from 0 to 1). In adults this task provided a less biased index of the spatial representation of number magnitude. Yet, so far there are no children data available for the unbounded number line estimation task. Therefore, we conducted a cross-sectional study on primary school children performing both, the bounded and the unbounded version of the task. We observed clear evidence for systematic strategic influences (i.e., the consideration of reference points) in the bounded number line estimation task for children older than grade two whereas there were no such indications for the unbounded version for any one of the age groups. In summary, the current data corroborate the unbounded number line estimation task to be a valuable tool for assessing children's spatial representation of number magnitude in a systematic and unbiased manner. Yet, similar results for the bounded and the unbounded version of the task for first- and second-graders may indicate that both versions of the task might assess the same underlying representation for relatively younger children—at least in number ranges familiar to the children assessed. This is of particular importance for inferences about the nature and development of children's magnitude representation. PMID:24478734

Probability and surprisal in auditory comprehension of morphologically complex words.

PubMed

Balling, Laura Winther; Baayen, R Harald

2012-10-01

Two auditory lexical decision experiments document for morphologically complex words two points at which the probability of a target word given the evidence shifts dramatically. The first point is reached when morphologically unrelated competitors are no longer compatible with the evidence. Adapting terminology from Marslen-Wilson (1984), we refer to this as the word's initial uniqueness point (UP1). The second point is the complex uniqueness point (CUP) introduced by Balling and Baayen (2008), at which morphologically related competitors become incompatible with the input. Later initial as well as complex uniqueness points predict longer response latencies. We argue that the effects of these uniqueness points arise due to the large surprisal (Levy, 2008) carried by the phonemes at these uniqueness points, and provide independent evidence that how cumulative surprisal builds up in the course of the word co-determines response latencies. The presence of effects of surprisal, both at the initial uniqueness point of complex words, and cumulatively throughout the word, challenges the Shortlist B model of Norris and McQueen (2008), and suggests that a Bayesian approach to auditory comprehension requires complementation from information theory in order to do justice to the cognitive cost of updating probability distributions over lexical candidates. Copyright © 2012 Elsevier B.V. All rights reserved.

Some Considerations Necessary for a Viable Theory of Human Memory.

ERIC Educational Resources Information Center

Sietsema, Douglas J.

Empirical research is reviewed in the area of cognitive psychology pertaining to models of human memory. Research evidence and theoretical considerations are combined to develop guidelines for future theory development related to the human memory. The following theoretical constructs and variables are discussed: (1) storage versus process…

Incipient triple point for adsorbed xenon monolayers: Pt(111) versus graphite substrates

NASA Astrophysics Data System (ADS)

Novaco, Anthony D.; Bruch, L. W.; Bavaresco, Jessica

2015-04-01

Simulation evidence of an incipient triple point is reported for xenon submonolayers adsorbed on the (111) surface of platinum. This is in stark contrast to the "normal" triple point found in simulations and experiments for xenon on the basal plane surface of graphite. The motions of the atoms in the surface plane are treated with standard 2D "NVE" molecular dynamics simulations using modern interactions. The simulation evidence strongly suggests an incipient triple point in the 120 -150 K range for adsorption on the Pt (111) surface while the adsorption on graphite shows a normal triple point at about 100 K.

Supermarket and grocery store-based interventions to promote healthful food choices and eating practices: a systematic review.

PubMed

Escaron, Anne L; Meinen, Amy M; Nitzke, Susan A; Martinez-Donate, Ana P

2013-04-11

Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed.

Supermarket and Grocery Store–Based Interventions to Promote Healthful Food Choices and Eating Practices: A Systematic Review

PubMed Central

Meinen, Amy M.; Nitzke, Susan A.; Martinez-Donate, Ana P.

2013-01-01

Introduction Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. Methods We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. Results We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. Conclusion More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed. PMID:23578398

Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives.

PubMed

Lindhardsen, Jesper; Kristensen, Søren Lund; Ahlehoff, Ole

2016-02-01

An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy in these conditions has stimulated considerable research and started an ongoing discussion on the need for a multidisciplinary approach and dedicated guidelines on CVD prevention in these patients. In addition, the possibility of inhibiting inflammation as a means to preventing CVD in these patients has gained considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD prevention in patients with CID.

The occurrence of phi in dento-facial beauty of fine art from antiquity through the Renaissance.

PubMed

Wiener, R Constance; Wiener Pla, Regina M

2012-01-01

External beauty is a complex construct that influences lives and may be impacted by dentists. Beauty is not easily quantified, but one cited anthropometric of beauty is the ratio phi, the number 1.618033(...). This study examined phi as a measure of female frontal facial beauty in classic Western art, using pre- Renaissance (N = 30), and Renaissance (N = 30) artwork. Four horizontal and five vertical ratios were determined in the works of art, which were then compared with the phi ratio. All horizontal ratios for both pre-Renaissance and Renaissance artwork were similar to each other, but did not contain the phi ratio (P < 0.001). Nevertheless, all vertical ratios for pre-Renaissance and Renaissance art-work did contain the phi ratio within their confidence intervals with the exception of the vertical ratio, "intereye point to soft tissue menton/ intereye point to stomion", that was found to be less than phi in the Renaissance group. The study provides evidence of the presence of the phi ratio in vertical aspect of females in artwork from pre-Renaissance through the Renaissance demonstrating consistent temporal preferences. Therefore, the phi ratio seems to be an important consideration in altering vertical facial dimensions in full mouth rehabilitation and reconstructive orthognathic surgery involving females.

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

PubMed Central

Ballas, Samir K.; Kesen, Muge R.; Goldberg, Morton F.; Lutty, Gerard A.; Dampier, Carlton; Osunkwo, Ifeyinwa; Wang, Winfred C.; Hoppe, Carolyn; Hagar, Ward; Darbari, Deepika S.; Malik, Punam

2012-01-01

The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes. PMID:22924029

The hidden ecological resource of andic soils in mountain ecosystems: evidence from Italy

NASA Astrophysics Data System (ADS)

Terribile, Fabio; Iamarino, Michela; Langella, Giuliano; Manna, Piero; Mileti, Florindo Antonio; Vingiani, Simona; Basile, Angelo

2018-01-01

Andic soils have unique morphological, physical, and chemical properties that induce both considerable soil fertility and great vulnerability to land degradation. Moreover, they are the most striking mineral soils in terms of large organic C storage and long C residence time. This is especially related to the presence of poorly crystalline clay minerals and metal-humus complexes. Recognition of andic soils is then very important.Here we attempt to show, through a combined analysis of 35 sampling points chosen in accordance to specific physical and vegetation rules, that some andic soils have an utmost ecological importance.More specifically, in Italian non-volcanic mountain ecosystems ( > 600 m a.s.l.) combining low slope (< 21 %) and highly active green biomass (high NDVI values) and in agreement to recent findings, we found the widespread occurrence of andic soils having distinctive physical and hydrological properties including low bulk density and remarkably high water retention. Most importantly, we report a demonstration of the ability of these soils to affect ecosystem functions by analysing their influence on the timescale acceleration of photosynthesis estimated by NDVI measurements.Our results are hoped to be a starting point for better understanding of the ecological importance of andic soils and also possibly to better consider pedological information in C balance calculations.

Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management.

PubMed

Ballas, Samir K; Kesen, Muge R; Goldberg, Morton F; Lutty, Gerard A; Dampier, Carlton; Osunkwo, Ifeyinwa; Wang, Winfred C; Hoppe, Carolyn; Hagar, Ward; Darbari, Deepika S; Malik, Punam

2012-01-01

The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.

Cost-of-illness studies of atrial fibrillation: methodological considerations.

PubMed

Becker, Christian

2014-10-01

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies' methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies' relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

Health research improves healthcare: now we have the evidence and the chance to help the WHO spread such benefits globally.

PubMed

Hanney, Stephen R; González-Block, Miguel A

2015-03-03

There has been a dramatic increase in the body of evidence demonstrating the benefits that come from health research. In 2014, the funding bodies for higher education in the UK conducted an assessment of research using an approach termed the Research Excellence Framework (REF). As one element of the REF, universities and medical schools in the UK submitted 1,621 case studies claiming to show the impact of their health and other life sciences research conducted over the last 20 years. The recently published results show many case studies were judged positively as providing examples of the wide range and extensive nature of the benefits from such research, including the development of new treatments and screening programmes that resulted in considerable reductions in mortality and morbidity.Analysis of specific case studies yet again illustrates the international dimension of progress in health research; however, as has also long been argued, not all populations fully share the benefits. In recognition of this, in May 2013 the World Health Assembly requested the World Health Organization (WHO) to establish a Global Observatory on Health Research and Development (R&D) as part of a strategic work-plan to promote innovation, build capacity, improve access, and mobilise resources to address diseases that disproportionately affect the world's poorest countries.As editors of Health Research Policy and Systems (HARPS), we are delighted that our journal has been invited to help inform the establishment of the WHO Global Observatory through a Call for Papers covering a range of topics relevant to the Observatory, including topics on which HARPS has published articles over the last few months, such as approaches to assessing research results, measuring expenditure data with a focus on R&D, and landscape analyses of platforms for implementing R&D. Topics related to research capacity building may also be considered. The task of establishing a Global Observatory on Health R&D to achieve the specified objectives will not be easy; nevertheless, this Call for Papers is well timed - it comes just at the point where the evidence of the benefits from health research has been considerably strengthened.

The research-design interaction: lessons learned from an evidence-based design studio.

PubMed

Haq, Saif; Pati, Debajyoti

2010-01-01

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD-the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.

Defect quasi Fermi level control-based CN reduction in GaN: Evidence for the role of minority carriers

NASA Astrophysics Data System (ADS)

Reddy, Pramod; Kaess, Felix; Tweedie, James; Kirste, Ronny; Mita, Seiji; Collazo, Ramon; Sitar, Zlatko

2017-10-01

Compensating point defect reduction in wide bandgap semiconductors is possible by above bandgap illumination based defect quasi Fermi level (dQFL) control. The point defect control technique employs excess minority carriers that influence the dQFL of the compensator, increase the corresponding defect formation energy, and consequently are responsible for point defect reduction. Previous studies on various defects in GaN and AlGaN have shown good agreement with the theoretical model, but no direct evidence for the role of minority carriers was provided. In this work, we provide direct evidence for the role of minority carriers in reducing point defects by studying the predicted increase in work done against defect (CN-1) formation with the decrease in the Fermi level (free carrier concentration) in Si doped GaN at a constant illumination intensity. Comparative defect photoluminescence measurements on illuminated and dark regions of GaN show an excellent quantitative agreement with the theory by exhibiting a greater reduction in yellow luminescence attributed to CN-1 at lower doping, thereby providing conclusive evidence for the role of the minority carriers in Fermi level control-based point defect reduction.

[The added value of information summaries supporting clinical decisions at the point-of-care.

PubMed

Banzi, Rita; González-Lorenzo, Marien; Kwag, Koren Hyogene; Bonovas, Stefanos; Moja, Lorenzo

2016-11-01

Evidence-based healthcare requires the integration of the best research evidence with clinical expertise and patients' values. International publishers are developing evidence-based information services and resources designed to overcome the difficulties in retrieving, assessing and updating medical information as well as to facilitate a rapid access to valid clinical knowledge. Point-of-care information summaries are defined as web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. Their validity must be assessed against marketing claims that they are evidence-based. We periodically evaluate the content development processes of several international point-of-care information summaries. The number of these products has increased along with their quality. The last analysis done in 2014 identified 26 products and found that three of them (Best Practice, Dynamed e Uptodate) scored the highest across all evaluated dimensions (volume, quality of the editorial process and evidence-based methodology). Point-of-care information summaries as stand-alone products or integrated with other systems, are gaining ground to support clinical decisions. The choice of one product over another depends both on the properties of the service and the preference of users. However, even the most innovative information system must rely on transparent and valid contents. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

Beverage-specific alcohol sales and violent mortality in Russia.

PubMed

Razvodovsky, Yury Evgeny

2010-01-01

High violent mortality rate in Russia and its profound fluctuation over recent decades have attracted considerable interest. A mounting body of evidence points to the binge drinking pattern as a potentially important contributor to the violent mortality crisis in Russia. In line with this evidence, we assume that higher level of vodka consumption in conjunction with binge drinking pattern results in close aggregate-level association between vodka sales and violent mortality rates in Russia. To test this hypothesis, trends in beverage-specific alcohol sales per capita and mortality rates from external causes in Russia between 1980 and 2005 were analyzed by means of ARIMA time-series analysis. Results of the analysis indicate that violent mortality rates tend to be more responsive to change in vodka sales per capita than to change in total level of alcohol sales. The analysis suggests that a 1-litre increase in vodka sales per capita would result in a 5% increase in violent mortality rate, an 11.3% increase in accidents and injuries mortality rate, a 9.2% increase in suicide rate, a 12.5% increase in homicide rate, and a 21.9% increase in fatal alcohol poisoning rate. The outcomes of this study provide support for the hypothesis that alcohol played a crucial role in the fluctuation in violent mortality rate in Russia in recent decades. Assuming that drinking vodka is usually associated with intoxication episodes, these findings provide additional evidence that the binge drinking pattern is an important determinant of the violent mortality crisis in Russia.

[Topics and considerations on reducing hospital admission: from evidence to practice].

PubMed

Amblàs Novellas, Jordi; Panicot, Joan Espaulella; Pueyo, Carles Blay; Brunet, Núria Molist; Lucchetti d'Aniello, Gianni E; Arisa, Antoni Anglada; Casas, Jordi Roca

2013-01-01

Demographic changes and the economic situation of the recent years have conditioned a turning point in health policies, which have decided to progressively prioritize chronicity care programs. Given that hospital costs were concentrated in attention to patients with chronic diseases, reduction on admissions is now a priority target. Meanwhile, we state that among the obviously community handling paradigmatic aim for those patients and the current care situation, there is a long way to do that should be done gradually. According to the current scientific evidence: Is it sensible to assume that there is a proper level of admissions or is it better for the patients to reduce the number of admissions? Is it possible to operationally and reliably define which hospital admissions are avoidable? Is it harmful to a patient and to the health care system to admit a patient with multiple chronic disease? Maybe are hospital admissions are avoidable and readmissions are indicators of a fragmented health care system? Given that situation, a reasonable approach requires firstly a critical analysis of the various realities of care (microsystems) and a systematic review of the scientific evidence-breaking, and rejecting some topics if necessary. Secondly, we should bring all this knowledge to clinical practice, conciliating «what» and the know-how, individual and population view, sole disease and multimorbidity, and finally clinical approach and health planning. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

Coronal bright points at 6cm wavelength

NASA Technical Reports Server (NTRS)

Fu, Qijun; Kundu, M. R.; Schmahl, E. J.

1988-01-01

Results are presented from observations of bright points at a wavelength of 6-cm using the VLA with a spatial resolution of 1.2 arcsec. During two hours of observations, 44 sources were detected with brightness temperatures between 2000 and 30,000 K. Of these sources, 27 are associated with weak dark He 10830 A features at distances less than 40 arcsecs. Consideration is given to variations in the source parameters and the relationship between ephemeral regions and bright points.

Giving bonus points based on oral exams

NASA Astrophysics Data System (ADS)

Ehrlich, Robert

2007-04-01

A pedagogical experiment of giving bonus points based on oral exams in an introductory physics course is described. The orals covered the questions on a written exam that had just been graded and returned to the class. Although the performance of most students on the oral exams was fair at best, the value of bonus point orals would appear to be considerable, even though it may not be applicable to large classes and have other important disadvantages.

Structure Line Detection from LIDAR Point Clouds Using Topological Elevation Analysis

NASA Astrophysics Data System (ADS)

Lo, C. Y.; Chen, L. C.

2012-07-01

Airborne LIDAR point clouds, which have considerable points on object surfaces, are essential to building modeling. In the last two decades, studies have developed different approaches to identify structure lines using two main approaches, data-driven and modeldriven. These studies have shown that automatic modeling processes depend on certain considerations, such as used thresholds, initial value, designed formulas, and predefined cues. Following the development of laser scanning systems, scanning rates have increased and can provide point clouds with higher point density. Therefore, this study proposes using topological elevation analysis (TEA) to detect structure lines instead of threshold-dependent concepts and predefined constraints. This analysis contains two parts: data pre-processing and structure line detection. To preserve the original elevation information, a pseudo-grid for generating digital surface models is produced during the first part. The highest point in each grid is set as the elevation value, and its original threedimensional position is preserved. In the second part, using TEA, the structure lines are identified based on the topology of local elevation changes in two directions. Because structure lines can contain certain geometric properties, their locations have small relieves in the radial direction and steep elevation changes in the circular direction. Following the proposed approach, TEA can be used to determine 3D line information without selecting thresholds. For validation, the TEA results are compared with those of the region growing approach. The results indicate that the proposed method can produce structure lines using dense point clouds.

Curriculum/Resource Development: The "C.A.R.E for St. Lucia" Resource Pack.

ERIC Educational Resources Information Center

Strong, Michelle

1993-01-01

Describes a resource packet that utilizes a four-point approach to make environmental action concerning land use more accessible to teachers. The points are construct a map of the area under consideration; assess the impact of historical development, natural cycles, mining, and eco-tourism on the problem; research land use options; and encourage…

Some biodiversity points and suggestions for the Myanmar Protected Area System

Treesearch

Daniel H. Henning

2007-01-01

This paper is divided into a brief background section followed by Part I: Biodiversity Points, and Part II: Suggestions that are needed for the ecological integrity of actual and potential protected areas in Myanmar. Part I consists of general and Myanmar Biodiversity Considerations, and Part II consists of the following suggestions: (l) international financial and...

Point source detection in infrared astronomical surveys

NASA Technical Reports Server (NTRS)

Pelzmann, R. F., Jr.

1977-01-01

Data processing techniques useful for infrared astronomy data analysis systems are reported. This investigation is restricted to consideration of data from space-based telescope systems operating as survey instruments. In this report the theoretical background for specific point-source detection schemes is completed, and the development of specific algorithms and software for the broad range of requirements is begun.

Dish concentrators for solar thermal energy: Status and technology development

NASA Technical Reports Server (NTRS)

Jaffe, L. D.

1982-01-01

Point-focusing concentrators under consideration for solar thermal energy use are reviewed. These concentrators differ in such characteristics as optical configuration, optical materials, structure for support of the optical elements and of the receiver, mount, foundation, drive, controls and enclosure. Concentrator performance and cost are considered. Technology development is outlined, including wind loads and aerodynamics; precipitation, sand, and seismic considerations; and maintenance and cleaning.

Operational considerations to reduce solar array loads

NASA Technical Reports Server (NTRS)

Gerstenmaier, W.

1992-01-01

The key parameters associated with solar array plume loads are examined, and operational considerations aimed at minimizing the effect of the Shuttle plumes on the Space Station solar arrays are discussed. These include solar array pointing to reduce loads and restrictions on Shuttle piloting. Particular attention is given to the method used to obtain the forcing functions (thruster time firing histories) for solar array plume calculation.

Mindfulness-based stress reduction for veterans exposed to military sexual trauma: rationale and implementation considerations.

PubMed

Gallegos, Autumn M; Cross, Wendi; Pigeon, Wilfred R

2015-06-01

Military sexual trauma (MST) represents a significant public health concern among military personnel and Veterans and is associated with considerable morbidity and suicide risk. It is estimated that 22% of Veteran women and 1% of Veteran men experienced sexual assault or repeated, threatening sexual harassment during their military service. Exposure to traumatic stress has detrimental effects on emotion regulation, which refers to a set of strategies used to modulate different components of emotion at different points on the trajectory of an emotional response. Mindfulness-based interventions offer approaches to health that focus on mind and body practices that can help regulate the experience and expression of difficult emotions. Mindfulness-based stress reduction (MBSR) is an evidence-based therapy shown to be effective for depression, anxiety, and post-traumatic stress disorder. This article discusses the rationale for providing MBSR to Veterans who have been exposed to MST. The article also discusses ways to facilitate implementation of this practice in the U.S. Department of Veterans Affairs health care system. We address potential barriers to care and ways to facilitate implementation at the patient, provider, organization/local, and policy levels. MBSR is likely to be an important component of a comprehensive approach to care for Veterans exposed to MST. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

EVA Performance Prediction

NASA Technical Reports Server (NTRS)

Peacock, Brian; Maida, James; Rajulu, Sudhakar

2004-01-01

Astronaut physical performance capabilities in micro gravity EV A or on planetary surfaces when encumbered by a life support suit and debilitated by a long exposure to micro gravity will be less than unencumbered pre flight capabilities. The big question addressed by human factors engineers is: what can the astronaut be expected to do on EVA or when we arrive at a planetary surface? A second question is: what aids to performance will be needed to enhance the human physical capability? These questions are important for a number of reasons. First it is necessary to carry out accurate planning of human physical demands to ensure that time and energy critical tasks can be carried out with confidence. Second it is important that the crew members (and their ground or planetary base monitors) have a realistic picture of their own capabilities, as excessive fatigue can lead to catastrophic failure. Third it is important to design appropriate equipment to enhance human sensory capabilities, locomotion, materials handling and manipulation. The evidence from physiological research points to musculoskeletal, cardiovascular and neurovestibular degradation during long duration exposure to micro gravity . The evidence from the biomechanics laboratory (and the Neutral Buoyancy Laboratory) points to a reduction in range of motion, strength and stamina when encumbered by a pressurized suit. The evidence from a long history of EVAs is that crewmembers are indeed restricted in their physical capabilities. There is a wealth of evidence in the literature on the causes and effects of degraded human performance in the laboratory, in sports and athletics, in industry and in other physically demanding jobs. One approach to this challenge is through biomechanical and performance modeling. Such models must be based on thorough task analysis, reliable human performance data from controlled studies, and functional extrapolations validated in analog contexts. The task analyses currently carried out for EVA activities are based more on extensive domain experience than any formal analytic structure. Conversely, physical task analysis for industrial and structured evidence from training and EV A contexts. Again on earth there is considerable evidence of human performance degradation due to encumbrance and fatigue. These industrial models generally take the form of a discounting equation. The development of performance estimates for space operations, such as timeline predictions for EVA is generally based on specific input from training activity, for example in the NBL or KC135. uniformed services tasks on earth are much more formalized. Human performance data in the space context has two sources: first there is the micro analysis of performance in structured tasks by the space physiology community and second there is the less structured evidence from training and EV A contexts.

Physician Evaluation of Internet Health Information on Proton Therapy for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shah, Anand, E-mail: as4351@columbia.edu; Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Paly, Jonathan J.

Purpose: Many patients considering prostate cancer (PCa) treatment options report seeking proton beam therapy (PBT) based in part on information readily available on the Internet. There is, however, potential for considerable variation in Internet health information (IHI). We thus evaluated the characteristics, quality, and accuracy of IHI on PBT for PCa. Methods and Materials: We undertook a qualitative research study using snowball-purposive sampling in which we evaluated the top 50 Google search results for “proton prostate cancer.” Quality was evaluated on a 5-point scale using the validated 15-question DISCERN instrument. Accuracy was evaluated by comparing IHI with the best availablemore » evidence. Results: Thirty-seven IHI websites were included in the final sample. These websites most frequently were patient information/support resources (46%), were focused exclusively on PBT (51%), and had a commercial affiliation (38%). There was a significant difference in quality according to the type of IHI. Substantial inaccuracies were noted in the study sample compared with best available or contextual evidence. Conclusions: There are shortcomings in quality and accuracy in consumer-oriented IHI on PBT for PCa. Providers must be prepared to educate patients how to critically evaluate IHI related to PBT for PCa to best inform their treatment decisions.« less

The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations.

PubMed

Torchalla, Iris; Strehlau, Verena

2018-03-01

The purpose of this study was to summarize the evidence base for interventions targeting individuals with work-related posttraumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers' compensation claim context. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 11 articles. Study populations included railroad personnel, police officers, disaster workers, and individuals with industrial injuries. Interventions included trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing. Several studies specifically targeted workers who had failed to return to work (RTW) after standard PTSD treatment. The results suggest that psychotherapy interventions are beneficial for helping clients recover from PTSD symptoms and RTW. In studies that reported on work status, RTW rates increased over time and generally lay between 58% and 80% across follow-up time points. Narrative impressions were supplemented by calculation of Risk Differences for individuals working at pretreatment versus posttreatment. Clinical consideration, methodological issues limiting the current body of work, and recommendations for future research are discussed.

Weighing in on the hidden Asian American obesity epidemic.

PubMed

Yi, Stella S; Kwon, Simona C; Wyatt, Laura; Islam, Nadia; Trinh-Shevrin, Chau

2015-04-01

According to national estimates, obesity prevalence is lower in Asian Americans compared to other racial/ethnic groups, but this low prevalence may be misleading for three reasons. First, a lower body mass index (BMI) cutoff as proposed by the World Health Organization may be more appropriate to use in Asian populations. However, evidence is limited to substantiate the potential costs and burden of adopting these cutoffs. Increasing BMI in Asians (as in other racial/ethnic groups) should be considered across the spectrum of BMI, with a minimum awareness of these lower cutoffs among healthcare researchers. Second, the need for disaggregated data across Asian American subgroups is illustrated by the higher obesity (and diabetes) prevalence estimates observed in South Asian Americans. Third, prevalence of obesity should be placed in the larger context of immigration and globalization through cross-national comparisons and examination of acculturation-related factors. However these types of studies and collection of salient variables are not routinely performed. Data from a metropolitan area where many Asian Americans settle is presented as a case study to illustrate these points. Clear evidence that incorporates these three considerations is necessary for program planning and resource allocation for obesity-related disparities in this rapidly growing and diverse population. Copyright © 2015 Elsevier Inc. All rights reserved.

The Genetics of Autism: Key Issues, Recent Findings and Clinical Implications

PubMed Central

El-Fishawy, Paul; State, Matthew W.

2010-01-01

Autism spectrum disorders (ASD’S) are highly heritable. Consequently, gene discovery promises to help illuminate the pathophysiology of these syndromes, yielding important opportunities for the development of novel treatments and a more nuanced understanding of the natural history of these disorders. Although the underlying genetic architecture of ASD’s is not yet known, the literature demonstrates that it is not, writ large, a monogenic disorder with Mendelian inheritance, but rather a group of complex genetic syndromes with risk deriving from genetic variations in multiple genes. The widely accepted “Common Disease-Common Variant” hypothesis predicts that the risk alleles in ASD’s and other complex disorders will be common in the general population. However, recent evidence from gene discovery efforts in a wide range of diseases raises important questions regarding the overall applicability of the theory and the extent of its usefulness in explaining individual genetic liability. In contrast, considerable evidence points to the importance of rare alleles both with regard to their value in providing a foothold into the molecular mechanisms of ASD and their overall contribution to the population-wide risk. This chapter reviews the origins of the common versus rare variant debate, highlights recent findings in the field, and addresses the clinical implications of both common and rare variant discoveries. PMID:20159341

Regulation of alternative splicing by local histone modifications: potential roles for RNA-guided mechanisms

PubMed Central

Zhou, Hua-Lin; Luo, Guangbin; Wise, Jo Ann; Lou, Hua

2014-01-01

The molecular mechanisms through which alternative splicing and histone modifications regulate gene expression are now understood in considerable detail. Here, we discuss recent studies that connect these two previously separate avenues of investigation, beginning with the unexpected discoveries that nucleosomes are preferentially positioned over exons and DNA methylation and certain histone modifications also show exonic enrichment. These findings have profound implications linking chromatin structure, histone modification and splicing regulation. Complementary single gene studies provided insight into the mechanisms through which DNA methylation and histones modifications modulate alternative splicing patterns. Here, we review an emerging theme resulting from these studies: RNA-guided mechanisms integrating chromatin modification and splicing. Several groundbreaking papers reported that small noncoding RNAs affect alternative exon usage by targeting histone methyltransferase complexes to form localized facultative heterochromatin. More recent studies provided evidence that pre-messenger RNA itself can serve as a guide to enable precise alternative splicing regulation via local recruitment of histone-modifying enzymes, and emerging evidence points to a similar role for long noncoding RNAs. An exciting challenge for the future is to understand the impact of local modulation of transcription elongation rates on the dynamic interplay between histone modifications, alternative splicing and other processes occurring on chromatin. PMID:24081581

Tai Chi exercise and the improvement of health and well-being in older adults.

PubMed

Yau, Matthew Kwai-sang

2008-01-01

Activity participation has a positive impact on both quantity and quality of life (QOL). Regular participations in physical, social, and cultural activities are associated with successful aging. There is considerable evidence that Tai Chi has positive health benefits; physical, psychosocial and therapeutic. Furthermore, Tai Chi does not only consist of a physical component, but also sociocultural, meditative components that are believed to contribute to overall well-being. This chapter describes the benefits of Tai Chi exercise for the older adults, particularly in terms of the psychosocial aspect. The perceived meanings, associated values and well-being, as well as the impact on QOL, of Tai Chi practice among the older adults in Hong Kong are also discussed. Tai Chi exercise is chosen by the elderly participants for its gentle and soft movements. Besides the physical aspect, the benefits they describe include lifestyle issues, as well as psychological and social benefits. Evidence points out that the improvements in physical and mental health through the practice of Tai Chi among the older adults are related to their perceived level of QOL. Findings from numerous studies support the belief that the practice of Tai Chi has multiple benefits to practitioners that are not only physical in nature. It is recommended as a strategy to promote successful aging.

Adjuvant chemotherapy for gastric cancer: Current evidence and future challenges

PubMed Central

Miceli, Rosalba; Tomasello, Gianluca; Bregni, Giacomo; Di Bartolomeo, Maria; Pietrantonio, Filippo

2014-01-01

Gastric cancer still represents one of the major causes of cancer mortality worldwide. Patients survival is mainly related to stage, with a high proportion of patients with metastatic disease at presentation. Thus, the cure rate largely depend upon surgical resection. Despite the additional, albeit small, benefit of adjuvant chemotherapy has been clearly demonstrated, no general consensus has been reached on the best treatment option. Moreover, the narrow therapeutic index of adjuvant chemotherapy (i.e., limited survival benefit with considerable toxicity) requires a careful assessment of expected risks and benefits for individual patients. Treatment choices vary widely based on the different geographic areas, with chemotherapy alone more often preferred in Europe or Asia and chemoradiotherapy in the United States. In the present review we discuss the current evidence and future challenges regarding adjuvant chemotherapy in curatively resected gastric cancer with particular emphasis on the recently completed landmark studies and meta-analyses. The most recent patient-level meta-analysis demonstrated the benefit of adjuvant chemotherapy over curative surgery; the same Authors also showed that disease-free survival may be used as a surrogate end-point for overall survival. We finally discuss future research issues such as the need of economic evaluations, development of prognostic or predictive biomarkers, and the unmet clinical need of trials comparing perioperative chemotherapy with adjuvant treatment. PMID:24782604

Heterogeneity of rabbit endogenous pyrogens is not attributable to glycosylated variants of a single polypeptide chain.

PubMed

Murphy, P A; Cebula, T A; Windle, B E

1981-10-01

Rabbit endogenous pyrogens were of about the same molecular size, but showed considerable heterogeneity of their isoelectric points. We attempted to show that this heterogeneity was attributable to variable glycosylation of a single polypeptide chain. When peritoneal exudate cells were stimulated to make pyrogens in the presence of 2-deoxy-D-glucose, there was a relatively trivial suppression of pyrogen release, and analysis by isoelectric focusing showed parallel inhibition of secretion of all the forms of endogenous pyrogen. When cells were stimulated in the presence of 3H-labeled amino acids and 14C-labeled glucosamine or glucose, the purified pyrogens were labeled with 3H but not with 14C. Macrophage membrane preparations were made which contained glycosyl transferases and could transfer sugar residues from sugar nucleotides to deglycosylated fetuin. These macrophage membrane preparations did not transfer sugars to the pI 7.3 endogenous pyrogen. Treatment of endogenous pyrogens with neuraminidase or with periodate produced no evidence suggesting that the pyrogens were glycosylated. Last, endogenous pyrogens did not bind to any of four lectins with different carbohydrate specificities. This evidence suggests that the heterogeneity of rabbit endogenous pyrogens is not attributable to glycosylation and must have some other cause.

Heterogeneity of rabbit endogenous pyrogens is not attributable to glycosylated variants of a single polypeptide chain.

PubMed Central

Murphy, P A; Cebula, T A; Windle, B E

1981-01-01

Rabbit endogenous pyrogens were of about the same molecular size, but showed considerable heterogeneity of their isoelectric points. We attempted to show that this heterogeneity was attributable to variable glycosylation of a single polypeptide chain. When peritoneal exudate cells were stimulated to make pyrogens in the presence of 2-deoxy-D-glucose, there was a relatively trivial suppression of pyrogen release, and analysis by isoelectric focusing showed parallel inhibition of secretion of all the forms of endogenous pyrogen. When cells were stimulated in the presence of 3H-labeled amino acids and 14C-labeled glucosamine or glucose, the purified pyrogens were labeled with 3H but not with 14C. Macrophage membrane preparations were made which contained glycosyl transferases and could transfer sugar residues from sugar nucleotides to deglycosylated fetuin. These macrophage membrane preparations did not transfer sugars to the pI 7.3 endogenous pyrogen. Treatment of endogenous pyrogens with neuraminidase or with periodate produced no evidence suggesting that the pyrogens were glycosylated. Last, endogenous pyrogens did not bind to any of four lectins with different carbohydrate specificities. This evidence suggests that the heterogeneity of rabbit endogenous pyrogens is not attributable to glycosylation and must have some other cause. PMID:6271680

A Race to the Top? Competitive Pressure and Magnet Adoption Among US Hospitals 1997-2012.

PubMed

Richards, Michael R; Lasater, Karen; McHugh, Matthew

2017-04-01

Care quality continues to be a focal point within US health care. One quality innovation is the Magnet recognition program for hospitals, which is a nurse-driven initiative emphasizing care and patient-safety improvements. To date, Magnet hospitals have been associated with better outcomes, but their distribution is highly uneven. Relatedly, little research has characterized what factors drive Magnet adoption (eg, competitive pressure from other hospitals). To examine if hospitals respond to more competing hospitals becoming Magnets by also becoming Magnet institutions. We use longitudinal data from the American Hospital Association, 1997-2012, and estimate hospital-level fixed-effect regressions to capture the association between Magnet adoption among competitors and a hospital's own likelihood of becoming a Magnet. We also explore heterogeneity in the relationships according to a hospital's standing within its market. Having more competitors become Magnets strongly predicts that a given hospital seeks Magnet recognition; yet, a hospital's market position and prevailing competition levels are moderating influences. A large literature links Magnet hospitals with better outcomes for patients and nurses, and more recent evidence suggests a business case for becoming a Magnet. We find evidence that hospitals seem motivated by competitive pressure, which suggests economic considerations in the decision to invest in costly care improvements.

A Race to the Top?

PubMed Central

Lasater, K.; McHugh, M.

2016-01-01

Background Care quality continues to be a focal point within US health care. One quality innovation is the Magnet recognition program for hospitals, which is a nurse-driven initiative emphasizing care and patient safety improvements. To date, Magnet hospitals have been associated with better outcomes, but their distribution is highly uneven. Relatedly, little research has characterized what factors drive Magnet adoption (e.g., competitive pressure from other hospitals). Objective To examine if hospitals respond to more competing hospitals becoming Magnets by also becoming Magnet institutions. Research Design We use longitudinal data from the American Hospital Association, 1997 – 2012, and estimate hospital-level fixed effect regressions to capture the association between Magnet adoption among competitors and a hospital’s own likelihood of becoming a Magnet. We also explore heterogeneity in the relationships according to a hospital’s standing within its market. Results Having more competitors become Magnets strongly predicts that a given hospital seeks Magnet recognition; yet, a hospital’s market position and prevailing competition levels are moderating influences. Conclusions A large literature links Magnet hospitals with better outcomes for patients and nurses, and more recent evidence suggests a business case for becoming a Magnet. We find evidence that hospitals appear motivated by competitive pressure, which suggests economic considerations in the decision to invest in costly care improvements. PMID:27635598

Parameter Heterogeneity In Breast Cancer Cost Regressions – Evidence From Five European Countries

PubMed Central

Banks, Helen; Campbell, Harry; Douglas, Anne; Fletcher, Eilidh; McCallum, Alison; Moger, Tron Anders; Peltola, Mikko; Sveréus, Sofia; Wild, Sarah; Williams, Linda J.; Forbes, John

2015-01-01

Abstract We investigate parameter heterogeneity in breast cancer 1‐year cumulative hospital costs across five European countries as part of the EuroHOPE project. The paper aims to explore whether conditional mean effects provide a suitable representation of the national variation in hospital costs. A cohort of patients with a primary diagnosis of invasive breast cancer (ICD‐9 codes 174 and ICD‐10 C50 codes) is derived using routinely collected individual breast cancer data from Finland, the metropolitan area of Turin (Italy), Norway, Scotland and Sweden. Conditional mean effects are estimated by ordinary least squares for each country, and quantile regressions are used to explore heterogeneity across the conditional quantile distribution. Point estimates based on conditional mean effects provide a good approximation of treatment response for some key demographic and diagnostic specific variables (e.g. age and ICD‐10 diagnosis) across the conditional quantile distribution. For many policy variables of interest, however, there is considerable evidence of parameter heterogeneity that is concealed if decisions are based solely on conditional mean results. The use of quantile regression methods reinforce the need to consider beyond an average effect given the greater recognition that breast cancer is a complex disease reflecting patient heterogeneity. © 2015 The Authors. Health Economics Published by John Wiley & Sons Ltd. PMID:26633866

78 FR 48674 - Announcement of the IRIS Public Meeting Schedule for Calendar Years 2013 and 2014; Announcement...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...; methodological considerations that could affect the interpretation of or confidence in study results; and... summarizing key characteristics and findings from critical studies that EPA proposes to consider in..., screening studies for consideration, and selecting studies to include in evidence tables, are responsive to...

Further Commentary on Mitochondrial Dysfunction in Autism Spectrum Disorder: Assessment and Treatment Considerations

ERIC Educational Resources Information Center

Dager, Stephen R.; Corrigan, Neva M.; Estes, Annette; Shaw, Dennis W. W.

2012-01-01

The authors respond to a recent letter (Rossignol and Frye 2011) critical of their paper, "Proton magnetic resonance spectroscopy and MRI reveal no evidence for brain mitochondrial dysfunction in children with autism spectrum disorder" (Corrigan et al. 2011). Further considerations regarding the assessment of mitochondrial dysfunction in autism…

The Semistructured Interview for Consideration of Ethnic Culture in Therapy Scale: Initial Psychometric and Outcome Support

ERIC Educational Resources Information Center

Donohue, Brad; Strada, Marilyn J.; Rosales, Rocio; Taylor-Caldwell, Aundrea; Hise, Dortha; Ahman, Sarah; Lefforge, Noelle L.; Kopof, Monique; Devore, Greg; Soares, Bruno; Radkovich, Ben; Laino, Rowena

2006-01-01

There has been recent pressure for practitioners to consider cultural variables when implementing evidence-based interventions. Therefore, the Semistructured Interview for Consideration of Ethnic Culture in Therapy Scale (SSICECTS) was empirically developed to address this issue. First, psychometric properties of a 6-item scale were evaluated in…

Integrating statistical and clinical research elements in intervention-related grant applications: summary from an NIMH workshop.

PubMed

Sherrill, Joel T; Sommers, David I; Nierenberg, Andrew A; Leon, Andrew C; Arndt, Stephan; Bandeen-Roche, Karen; Greenhouse, Joel; Guthrie, Donald; Normand, Sharon-Lise; Phillips, Katharine A; Shear, M Katherine; Woolson, Robert

2009-01-01

The authors summarize points for consideration generated in a National Institute of Mental Health (NIMH) workshop convened to provide an opportunity for reviewers from different disciplines-specifically clinical researchers and statisticians-to discuss how their differing and complementary expertise can be well integrated in the review of intervention-related grant applications. A 1-day workshop was convened in October, 2004. The workshop featured panel presentations on key topics followed by interactive discussion. This article summarizes the workshop and subsequent discussions, which centered on topics including weighting the statistics/data analysis elements of an application in the assessment of the application's overall merit; the level of statistical sophistication appropriate to different stages of research and for different funding mechanisms; some key considerations in the design and analysis portions of applications; appropriate statistical methods for addressing essential questions posed by an application; and the role of the statistician in the application's development, study conduct, and interpretation and dissemination of results. A number of key elements crucial to the construction and review of grant applications were identified. It was acknowledged that intervention-related studies unavoidably involve trade-offs. Reviewers are helped when applications acknowledge such trade-offs and provide good rationale for their choices. Clear linkage among the design, aims, hypotheses, and data analysis plan and avoidance of disconnections among these elements also strengthens applications. The authors identify multiple points to consider when constructing intervention-related grant applications. The points are presented here as questions and do not reflect institute policy or comprise a list of best practices, but rather represent points for consideration.

Prism adaptation does not alter object-based attention in healthy participants.

PubMed

Bultitude, Janet H; List, Alexandra; Aimola Davies, Anne M

2013-01-01

Hemispatial neglect ('neglect') is a disabling condition that can follow damage to the right side of the brain, in which patients show difficulty in responding to or orienting towards objects and events that occur on the left side of space. Symptoms of neglect can manifest in both space- and object-based frames of reference. Although patients can show a combination of these two forms of neglect, they are considered separable and have distinct neurological bases. In recent years considerable evidence has emerged to demonstrate that spatial symptoms of neglect can be reduced by an intervention called prism adaptation. Patients point towards objects viewed through prismatic lenses that shift the visual image to the right. Approximately five minutes of repeated pointing results in a leftward recalibration of pointing and improved performance on standard clinical tests for neglect. The understanding of prism adaptation has also been advanced through studies of healthy participants, in whom adaptation to leftward prismatic shifts results in temporary neglect-like performance. Here we examined the effect of prism adaptation on the performance of healthy participants who completed a computerised test of space- and object-based attention. Participants underwent adaptation to leftward- or rightward-shifting prisms, or performed neutral pointing according to a between-groups design. Significant pointing after-effects were found for both prism groups, indicating successful adaptation. In addition, the results of the computerised test revealed larger reaction-time costs associated with shifts of attention between two objects compared to shifts of attention within the same object, replicating previous work. However there were no differences in the performance of the three groups, indicating that prism adaptation did not influence space- or object-based attention for this task. When combined with existing literature, the results are consistent with the proposal that prism adaptation may only perturb cognitive functions for which normal baseline performance is already biased.

Prism adaptation does not alter object-based attention in healthy participants

PubMed Central

Bultitude, Janet H.

2013-01-01

Hemispatial neglect (‘neglect’) is a disabling condition that can follow damage to the right side of the brain, in which patients show difficulty in responding to or orienting towards objects and events that occur on the left side of space. Symptoms of neglect can manifest in both space- and object-based frames of reference. Although patients can show a combination of these two forms of neglect, they are considered separable and have distinct neurological bases. In recent years considerable evidence has emerged to demonstrate that spatial symptoms of neglect can be reduced by an intervention called prism adaptation. Patients point towards objects viewed through prismatic lenses that shift the visual image to the right. Approximately five minutes of repeated pointing results in a leftward recalibration of pointing and improved performance on standard clinical tests for neglect. The understanding of prism adaptation has also been advanced through studies of healthy participants, in whom adaptation to leftward prismatic shifts results in temporary neglect-like performance. Here we examined the effect of prism adaptation on the performance of healthy participants who completed a computerised test of space- and object-based attention. Participants underwent adaptation to leftward- or rightward-shifting prisms, or performed neutral pointing according to a between-groups design. Significant pointing after-effects were found for both prism groups, indicating successful adaptation. In addition, the results of the computerised test revealed larger reaction-time costs associated with shifts of attention between two objects compared to shifts of attention within the same object, replicating previous work. However there were no differences in the performance of the three groups, indicating that prism adaptation did not influence space- or object-based attention for this task. When combined with existing literature, the results are consistent with the proposal that prism adaptation may only perturb cognitive functions for which normal baseline performance is already biased. PMID:24715960

Patterns of Use of Peripheral Nerve Blocks and Trigger Point Injections for Pediatric Headache: Results of a survey of the American Headache Society Pediatric & Adolescent Section

PubMed Central

Szperka, Christina L.; Gelfand, Amy A.; Hershey, Andrew D.

2016-01-01

Objective To describe current patterns of use of nerve blocks and trigger point injections for treatment of pediatric headache. Background Peripheral nerve blocks are often used to treat headaches in adults and children, but the available studies and practice data from adult headache specialists have shown wide variability in diagnostic indications, sites injected, and medication(s) used. The purpose of this study was to describe current practice patterns in the use of nerve blocks and trigger point injections for pediatric headache disorders. Methods A survey was created in REDCap, and sent via email to the 82 members of the Pediatric & Adolescent Section of the American Headache Society in June 2015. The survey queried about current practice and use of nerve blocks, as well as respondents’ opinions regarding gaps in the evidence for use of nerve blocks in this patient population. Results Forty-one complete, 5 incomplete, and 3 duplicate responses were submitted (response rate complete 50%). Seventy-eight percent of the respondents identified their primary specialty as Child Neurology, and 51% were certified in headache medicine. Twenty-six (63%) respondents perform nerve blocks themselves, and 7 (17%) refer patients to another provider for nerve blocks. Chronic migraine with status migrainosus was the most common indication for nerve blocks (82%), though occipital neuralgia (79%), status migrainosus (73%), chronic migraine without flare (70%), post-traumatic headache (70%), and new daily persistent headache (67%) were also common indications. The most commonly selected clinically meaningful response for status migrainosus was ≥50% reduction in severity, while for chronic migraine this was a ≥50% decrease in frequency at 4 weeks. Respondents inject the following locations: 100% inject the greater occipital nerve, 69% lesser occipital nerve, 50% supraorbital, 46% trigger point injections, 42% auriculotemporal, and 34% supratrochlear. All respondents used local anesthetic, while 12 (46%) also use corticosteroid (8 bupivacaine only, 4 each lidocaine + bupivacaine, lidocaine + corticosteroid, bupivacaine + corticosteroid, lidocaine + bupivacaine + corticosteroid, and 2 lidocaine only). Conclusion Despite limited evidence, nerve blocks are commonly used by pediatric headache specialists. There is considerable variability among clinicians as to injection site(s) and medication selection, indicating a substantial gap in the literature to guide practice, and supporting the need for further research in this area. PMID:27731894

Three-dimensional dosimetric considerations from different point A definitions in cervical cancer low-dose-rate brachytherapy

PubMed Central

Chen, Ting; Kim, Leonard H.; Nelson, Carl; Gabel, Molly; Narra, Venkat; Haffty, Bruce; Yue, Ning J.

2013-01-01

Purpose To investigate the dosimetric difference due to the different point A definitions in cervical cancer low-dose-rate (LDR) intracavitary brachytherapy. Material and methods Twenty CT-based LDR brachytherapy plans of 11 cervical patients were retrospectively reviewed. Two plans with point As following the modified Manchester system which defines point A being 2 cm superior to the cervical os along the tandem and 2 cm lateral (Aos), and the American Brachytherapy Society (ABS) guideline definition in which the point A is 2 cm superior to the vaginal fornices instead of os (Aovoid) were generated. Using the same source strength, two plans prescribed the same dose to Aos and Aovoid. Dosimetric differences between plans including point A dose rate, treatment volume encompassed by the prescription isodose line (TV), and dose rate of 2 cc of the rectum and bladder to the prescription dose were measured. Results On average Aovoid was 8.9 mm superior to Aos along the tandem direction with a standard deviation of 5.4 mm. With the same source strength and arrangement, Aos dose rate was 19% higher than Aovoid dose rate. The average TV(Aovoid) was 118.0 cc, which was 30% more than the average TV(Aos) of 93.0 cc. D2cc/D(Aprescribe) increased from 51% to 60% for rectum, and increased from 89% and 106% for bladder, if the prescription point changed from Aos to Aovoid. Conclusions Different point A definitions lead to significant dose differences. Careful consideration should be given when changing practice from one point A definition to another, to ensure dosimetric and clinical equivalency from the previous clinical experiences. PMID:24474971

Are There Any Promising Biochemical Correlates of Achievement Behavior and Motivation? The Evidence for Serum Uric Acid and Serum Cholesterol

ERIC Educational Resources Information Center

Kasl, Stanislav V.

1974-01-01

This review examines the available evidence in support of the argument that serum uric acid (SUA) possesses considerable promise as an indicator of one type of biochemical influence on achievement behavior. The evidence arguing for further research into the role of serum cholesterol in achievement behavior is also examined. (Author/JR)

GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process.

PubMed

Pottie, Kevin; Welch, Vivian; Morton, Rachael; Akl, Elie A; Eslava-Schmalbach, Javier H; Katikireddi, Vittal; Singh, Jasvinder; Moja, Lorenzo; Lang, Eddy; Magrini, Nicola; Thabane, Lehana; Stanev, Roger; Matovinovic, Elizabeth; Snellman, Alexandra; Briel, Matthias; Shea, Beverly; Tugwell, Peter; Schunemann, Holger; Guyatt, Gordon; Alonso-Coello, Pablo

2017-10-01

The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup. Copyright © 2017 Elsevier Inc. All rights reserved.

Meta-analysis: exercise therapy for nonspecific low back pain.

PubMed

Hayden, Jill A; van Tulder, Maurits W; Malmivaara, Antti V; Koes, Bart W

2005-05-03

Exercise therapy is widely used as an intervention in low back pain. To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias. Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.

The effects of integrated care: a systematic review of UK and international evidence.

PubMed

Baxter, Susan; Johnson, Maxine; Chambers, Duncan; Sutton, Anthea; Goyder, Elizabeth; Booth, Andrew

2018-05-10

Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. Prospero registration number: 42016037725 .

Journal of Special Operations Medicine, Volume 7, Edition 4. Training Supplement: Tactics, Techniques, and Procedures

DTIC Science & Technology

2007-01-01

fatigued. The majority of the OIL and TTP listed here are oriented to the Level I management of combat CAX or management at the point of injury (POI) or...carried into the field by medical personnel. Time to evacuation from the POI or other casualty evacuation point (CEP) to an MTF may vary considerably...must be avoided during this time. Care must be rendered once the mission has reached an anticipated evacuation point , without pursuit, awaiting CASEVAC

Acupuncture for treating fibromyalgia

PubMed Central

Deare, John C; Zheng, Zhen; Xue, Charlie CL; Liu, Jian Ping; Shang, Jingsheng; Scott, Sean W; Littlejohn, Geoff

2014-01-01

Background One in five fibromyalgia sufferers use acupuncture treatment within two years of diagnosis. Objectives To examine the benefits and safety of acupuncture treatment for fibromyalgia. Search methods We searched CENTRAL, PubMed, EMBASE, CINAHL, National Research Register, HSR Project and Current Contents, as well as the Chinese databases VIP and Wangfang to January 2012 with no language restrictions. Selection criteria Randomised and quasi-randomised studies evaluating any type of invasive acupuncture for fibromyalgia diagnosed according to the American College of Rheumatology (ACR) criteria, and reporting any main outcome: pain, physical function, fatigue, sleep, total well-being, stiffness and adverse events. Data collection and analysis Two author pairs selected trials, extracted data and assessed risk of bias. Treatment effects were reported as standardised mean differences (SMD) and 95%confidence intervals (CI) for continuous outcomes using different measurement tools (pain, physical function, fatigue, sleep, total well-being and stiffness) and risk ratio (RR) and 95% CI for dichotomous outcomes (adverse events).We pooled data using the random-effects model. Main results Nine trials (395 participants) were included. All studies except one were at low risk of selection bias; five were at risk of selective reporting bias (favouring either treatment group); two were subject to attrition bias (favouring acupuncture); three were subject to performance bias (favouring acupuncture) and one to detection bias (favouring acupuncture). Three studies utilised electro-acupuncture (EA) with the remainder using manual acupuncture (MA) without electrical stimulation. All studies used ’formula acupuncture’ except for one, which used trigger points. Low quality evidence from one study (13 participants) showed EA improved symptoms with no adverse events at one month following treatment. Mean pain in the non-treatment control group was 70 points on a 100 point scale; EA reduced pain by a mean of 22 points (95% confidence interval (CI) 4 to 41), or 22% absolute improvement. Control group global well-being was 66.5 points on a 100 point scale; EA improved well-being by a mean of 15 points (95% CI 5 to 26 points). Control group stiffness was 4.8 points on a 0 to 10 point; EA reduced stiffness by a mean of 0.9 points (95% CI 0.1 to 2 points; absolute reduction 9%, 95% CI 4% to 16%). Fatigue was 4.5 points (10 point scale) without treatment; EA reduced fatigue by a mean of 1 point (95% CI 0.22 to 2 points), absolute reduction 11% (2% to 20%). There was no difference in sleep quality (MD 0.4 points, 95% CI −1 to 0.21 points, 10 point scale), and physical function was not reported. Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture, except for less stiffness at one month. Subgroup analysis of two studies (104 participants) indicated benefits of EA. Mean pain was 70 points on 0 to 100 point scale with sham treatment; EA reduced pain by 13% (5% to 22%); (SMD −0.63, 95% CI −1.02 to −0.23). Global well-being was 5.2 points on a 10 point scale with sham treatment; EA improved well-being: SMD 0.65, 95% CI 0.26 to 1.05; absolute improvement 11% (4% to 17%). EA improved sleep, from 3 points on a 0 to 10 point scale in the sham group: SMD 0.40 (95% CI 0.01 to 0.79); absolute improvement 8% (0.2% to 16%). Low-quality evidence from one study suggested that MA group resulted in poorer physical function: mean function in the sham group was 28 points (100 point scale); treatment worsened function by a mean of 6 points (95% CI −10.9 to −0.7). Low-quality evidence from three trials (289 participants) suggested no difference in adverse events between real (9%) and sham acupuncture (35%); RR 0.44 (95% CI 0.12 to 1.63). Moderate quality evidence from one study (58 participants) found that compared with standard therapy alone (antidepressants and exercise), adjunct acupuncture therapy reduced pain at one month after treatment: mean pain was 8 points on a 0 to 10 point scale in the standard therapy group; treatment reduced pain by 3 points (95% CI −3.9 to −2.1), an absolute reduction of 30% (21% to 39%). Two people treated with acupuncture reported adverse events; there were none in the control group (RR 3.57; 95% CI 0.18 to 71.21). Global well-being, sleep, fatigue and stiffness were not reported. Physical function data were not usable. Low quality evidence from one study (38 participants) showed a short-term benefit of acupuncture over antidepressants in pain relief: mean pain was 29 points (0 to 100 point scale) in the antidepressant group; acupuncture reduced pain by 17 points (95% CI −24.1 to −10.5). Other outcomes or adverse events were not reported. Moderate-quality evidence from one study (41 participants) indicated that deep needling with or without deqi did not differ in pain, fatigue, function or adverse events. Other outcomes were not reported. Four studies reported no differences between acupuncture and control or other treatments described at six to seven months follow-up. No serious adverse events were reported, but there were insufficient adverse events to be certain of the risks. Authors’ conclusions There is low tomoderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted. PMID:23728665

Promoting Evidence to Policy Link on the Control of Infectious Diseases of Poverty in Nigeria: Outcome of A Multi-Stakeholders Policy Dialogue

PubMed Central

Uneke, Chigozie Jesse; Ebeh Ezeoha, Abel; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima

2015-01-01

Background: In Nigeria, malaria, schistosomiasis and lymphatic filariasis are among infectious diseases of poverty (IDP) with severe health burden and require effective policy strategies for their control. In this study, we investigated the value of policy brief and policy dialogue as excellent policymaking mechanisms that enable policymakers to adapt effective evidence informed policy for IDP control. Methods: A policy brief was developed on the control of malaria, schistosomiasis and lymphatic filariasis and subjected to deliberations in a one-day multi-stakeholder policy dialogue held in Ebonyi State Nigeria. A modified cross sectional intervention study design was used in this investigation. Structured pre-tested questionnaires were used to evaluate the policy brief document and policy dialogue process at the end of the policy dialogue. Results: Forty-seven policymakers participated in the dialogue. An analysis of the response on the policy brief regarding context, different features of the problem; policy options and key implementation considerations indicated the mean ratings (MNRs) mostly ranged from 6.40-6.85 on 7 point scale. The over-all assessment of the policy brief had MNR at 6.54. The analysis of the response on the policy dialogue regarding the level of priority of policy issue, opportunity to discuss different features of the problem and options for addressing the problem, and the MNRs mostly ranged from 6.50-6.82. The overall assessment of the policy dialogue had MNR at 6.72. Conclusion: Policy dialogues can allow research evidence to be considered together with views, experiences and tacit knowledge of policymakers and can enhance evidence-to-policy link. PMID:26290826

Is Helicobacter pylori really the cause of gastric cancer?

PubMed

Nyrén, O

1998-08-01

Since 1994, when the International Agency for Research on Cancer (IARC) designated Helicobacter pylori a human carcinogen, a considerable number of new studies have examined the association of this microorganism with risk of gastric cancer. The aim of this review was to critically evaluate current evidence of a causal relationship between the infection and gastric cancer in humans, taking these new studies into account. A MEDLINE search for the years 1982 through March 1998 yielded eight cohort studies, 40 case-control studies and eight ecologic studies. They were divided into four categories according to the weight of the evidence produced. In the category producing the strongest evidence, the cohort studies, five out of eight studies (including the three that formed the basis for the IARC decision) found a statistically significant excess risk of gastric cancer among the infected with odds ratios ranging between 2.8 and 6.0. Two cohort studies showed a non-significant tendency towards a positive association, but with point estimates indicating no more than a 50-60% excess risk among the H. pylori seropositive, and one apparently well-performed cohort study was completely negative. The two population-based case-control studies published to date found statistically non-significant odds ratios no higher than 1.3 and 1.4. Thus, the evidence of a strong causal link between H. pylori infection and gastric cancer has, if anything, become less convincing. Recent studies seem to indicate that the strength of the association may vary with type of H. pylori strain, and possibly presence of effect-modifying co-factors in the host and/or the environment. Future studies need to identify high-risk constellations of carcinogenic strains and unfavorable co-factors to make targeted prophylaxis cost-effective.

Common fixed point theorems for maps under a contractive condition of integral type

NASA Astrophysics Data System (ADS)

Djoudi, A.; Merghadi, F.

2008-05-01

Two common fixed point theorems for mapping of complete metric space under a general contractive inequality of integral type and satisfying minimal commutativity conditions are proved. These results extend and improve several previous results, particularly Theorem 4 of Rhoades [B.E. Rhoades, Two fixed point theorems for mappings satisfying a general contractive condition of integral type, Int. J. Math. Math. Sci. 63 (2003) 4007-4013] and Theorem 4 of Sessa [S. Sessa, On a weak commutativity condition of mappings in fixed point considerations, Publ. Inst. Math. (Beograd) (N.S.) 32 (46) (1982) 149-153].

Evidence-Based Practices and Autism

ERIC Educational Resources Information Center

Mesibov, Gary B.; Shea, Victoria

2011-01-01

Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…

The Aging Male Homosexual: Myth and Reality

ERIC Educational Resources Information Center

Kelly, Jim

1977-01-01

There is little evidence to suggest that being gay causes problems in old age but there is considerable evidence to suggest that societal stigma may cause problems for aging gays. Presented at the 28th Annual Scientific Meeting of Gerontological Society, Louisville, Oct., 1975. (Author)

An Improved Evidential-IOWA Sensor Data Fusion Approach in Fault Diagnosis

PubMed Central

Zhou, Deyun; Zhuang, Miaoyan; Fang, Xueyi; Xie, Chunhe

2017-01-01

As an important tool of information fusion, Dempster–Shafer evidence theory is widely applied in handling the uncertain information in fault diagnosis. However, an incorrect result may be obtained if the combined evidence is highly conflicting, which may leads to failure in locating the fault. To deal with the problem, an improved evidential-Induced Ordered Weighted Averaging (IOWA) sensor data fusion approach is proposed in the frame of Dempster–Shafer evidence theory. In the new method, the IOWA operator is used to determine the weight of different sensor data source, while determining the parameter of the IOWA, both the distance of evidence and the belief entropy are taken into consideration. First, based on the global distance of evidence and the global belief entropy, the α value of IOWA is obtained. Simultaneously, a weight vector is given based on the maximum entropy method model. Then, according to IOWA operator, the evidence are modified before applying the Dempster’s combination rule. The proposed method has a better performance in conflict management and fault diagnosis due to the fact that the information volume of each evidence is taken into consideration. A numerical example and a case study in fault diagnosis are presented to show the rationality and efficiency of the proposed method. PMID:28927017

Establishing Quantitative Within-Subject Confidence Limits For Clinical Stereoroentgenographs

NASA Astrophysics Data System (ADS)

Korn, Edward L.; Baumrind, Sheldon; Chafetz, Neil; Curry, Sean; Moffitt, Francis

1983-07-01

It is now quite clear that under ideal conditions, discrete points can be located on x-ray films with standard deviations of less than 50 i. However, under routine clinical conditions, such considerations as individual variation in anatomy, movement of the subject between exposures, and variations in image quality combine to produce considerable reductions in the confidence which can be placed in quantitative assessments made from stereoroentgenographic films. This paper discusses some considerations involved in designing mathematical models in such a way as to optimize the use of imperfect data in answering specific clinical questions.

Osteomyelitis: A Context for Wound Management.

PubMed

Groll, Mary E; Woods, Timothy; Salcido, Richard

2018-06-01

To provide an overview of osteomyelitis. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you should be able to:1. Distinguish the pathogenesis of osteomyelitis in children and adults.2. Identify practical considerations for diagnosis and evidence-based treatment of osteomyelitis. This educational activity reviews the pathogenesis of osteomyelitis and discusses practical considerations for diagnosis, treatment, and functional rehabilitation of pediatric and adult patients with osteomyelitic wounds. Antibiotic, surgical, and adjunctive treatments will be addressed. Emphasis is placed on consulting with infectious disease specialists and using evidence-based guidelines for antibiotic prescribing.

Emollient treatment of atopic dermatitis: latest evidence and clinical considerations

PubMed Central

Kung, Jeng Sum Charmaine; Ng, Wing Gi Gigi; Leung, Ting Fan

2018-01-01

Aim To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD) and considerations for choice of an emollient. Methods PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used. Overview of findings Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated. Conclusions A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/emollient; therefore, doctors should provide evidence-based information about these emollients. PMID:29692852

The Relationships among Shyness, Shame, and Attachment Style with Respect to College Student Persistence and Grade Point Average

ERIC Educational Resources Information Center

Lamana Finn, Kim

2017-01-01

The purpose of this study was to investigate the relationships between attachment style, shyness, shame, and college persistence and grade point average. While considerable research was conducted to examine these variables in children, less is known about how these variables interact in a college setting. This study used a quantitative,…

Designing a Feasibility Study: A Starting Point for Considering New Management Initiatives for Working Parents.

ERIC Educational Resources Information Center

Friedman, Dana E.

This brief paper was prepared as a starting point for employers considering the adoption of a new management initiative for working parents. It is not an exhaustive outline of all considerations in the decision-making process, nor does it provide solutions to all the known pitfalls. It does, however, suggest the potential scope and complexity of…

Generalized linear models and point count data: statistical considerations for the design and analysis of monitoring studies

Treesearch

Nathaniel E. Seavy; Suhel Quader; John D. Alexander; C. John Ralph

2005-01-01

The success of avian monitoring programs to effectively guide management decisions requires that studies be efficiently designed and data be properly analyzed. A complicating factor is that point count surveys often generate data with non-normal distributional properties. In this paper we review methods of dealing with deviations from normal assumptions, and we focus...

a Two-Step Classification Approach to Distinguishing Similar Objects in Mobile LIDAR Point Clouds

NASA Astrophysics Data System (ADS)

He, H.; Khoshelham, K.; Fraser, C.

2017-09-01

Nowadays, lidar is widely used in cultural heritage documentation, urban modeling, and driverless car technology for its fast and accurate 3D scanning ability. However, full exploitation of the potential of point cloud data for efficient and automatic object recognition remains elusive. Recently, feature-based methods have become very popular in object recognition on account of their good performance in capturing object details. Compared with global features describing the whole shape of the object, local features recording the fractional details are more discriminative and are applicable for object classes with considerable similarity. In this paper, we propose a two-step classification approach based on point feature histograms and the bag-of-features method for automatic recognition of similar objects in mobile lidar point clouds. Lamp post, street light and traffic sign are grouped as one category in the first-step classification for their inter similarity compared with tree and vehicle. A finer classification of the lamp post, street light and traffic sign based on the result of the first-step classification is implemented in the second step. The proposed two-step classification approach is shown to yield a considerable improvement over the conventional one-step classification approach.

Manual therapy and exercise for rotator cuff disease.

PubMed

Page, Matthew J; Green, Sally; McBain, Brodwen; Surace, Stephen J; Deitch, Jessica; Lyttle, Nicolette; Mrocki, Marshall A; Buchbinder, Rachelle

2016-06-10

Management of rotator cuff disease often includes manual therapy and exercise, usually delivered together as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. To synthesise available evidence regarding the benefits and harms of manual therapy and exercise, alone or in combination, for the treatment of people with rotator cuff disease. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCO, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. We included randomised and quasi-randomised trials, including adults with rotator cuff disease, and comparing any manual therapy or exercise intervention with placebo, no intervention, a different type of manual therapy or exercise or any other intervention (e.g. glucocorticoid injection). Interventions included mobilisation, manipulation and supervised or home exercises. Trials investigating the primary or add-on effect of manual therapy and exercise were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. We included 60 trials (3620 participants), although only 10 addressed the main comparisons of interest. Overall risk of bias was low in three, unclear in 14 and high in 43 trials. We were unable to perform any meta-analyses because of clinical heterogeneity or incomplete outcome reporting. One trial compared manual therapy and exercise with placebo (inactive ultrasound therapy) in 120 participants with chronic rotator cuff disease (high quality evidence). At 22 weeks, the mean change in overall pain with placebo was 17.3 points on a 100-point scale, and 24.8 points with manual therapy and exercise (adjusted mean difference (MD) 6.8 points, 95% confidence interval (CI) -0.70 to 14.30 points; absolute risk difference 7%, 1% fewer to 14% more). Mean change in function with placebo was 15.6 points on a 100-point scale, and 22.4 points with manual therapy and exercise (adjusted MD 7.1 points, 95% CI 0.30 to 13.90 points; absolute risk difference 7%, 1% to 14% more). Fifty-seven per cent (31/54) of participants reported treatment success with manual therapy and exercise compared with 41% (24/58) of participants receiving placebo (risk ratio (RR) 1.39, 95% CI 0.94 to 2.03; absolute risk difference 16% (2% fewer to 34% more). Thirty-one per cent (17/55) of participants reported adverse events with manual therapy and exercise compared with 8% (5/61) of participants receiving placebo (RR 3.77, 95% CI 1.49 to 9.54; absolute risk difference 23% (9% to 37% more). However adverse events were mild (short-term pain following treatment).Five trials (low quality evidence) found no important differences between manual therapy and exercise compared with glucocorticoid injection with respect to overall pain, function, active shoulder abduction and quality of life from four weeks up to 12 months. However, global treatment success was more common up to 11 weeks in people receiving glucocorticoid injection (low quality evidence). One trial (low quality evidence) showed no important differences between manual therapy and exercise and arthroscopic subacromial decompression with respect to overall pain, function, active range of motion and strength at six and 12 months, or global treatment success at four to eight years. One trial (low quality evidence) found that manual therapy and exercise may not be as effective as acupuncture plus dietary counselling and Phlogenzym supplement with respect to overall pain, function, active shoulder abduction and quality life at 12 weeks. We are uncertain whether manual therapy and exercise improves function more than oral non-steroidal anti-inflammatory drugs (NSAID), or whether combining manual therapy and exercise with glucocorticoid injection provides additional benefit in function over glucocorticoid injection alone, because of the very low quality evidence in these two trials.Fifty-two trials investigated effects of manual therapy alone or exercise alone, and the evidence was mostly very low quality. There was little or no difference in patient-important outcomes between manual therapy alone and placebo, no treatment, therapeutic ultrasound and kinesiotaping, although manual therapy alone was less effective than glucocorticoid injection. Exercise alone led to less improvement in overall pain, but not function, when compared with surgical repair for rotator cuff tear. There was little or no difference in patient-important outcomes between exercise alone and placebo, radial extracorporeal shockwave treatment, glucocorticoid injection, arthroscopic subacromial decompression and functional brace. Further, manual therapy or exercise provided few or no additional benefits when combined with other physical therapy interventions, and one type of manual therapy or exercise was rarely more effective than another. Despite identifying 60 eligible trials, only one trial compared a combination of manual therapy and exercise reflective of common current practice to placebo. We judged it to be of high quality and found no clinically important differences between groups in any outcome. Effects of manual therapy and exercise may be similar to those of glucocorticoid injection and arthroscopic subacromial decompression, but this is based on low quality evidence. Adverse events associated with manual therapy and exercise are relatively more frequent than placebo but mild in nature. Novel combinations of manual therapy and exercise should be compared with a realistic placebo in future trials. Further trials of manual therapy alone or exercise alone for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.

D Semantic Labeling of ALS Data Based on Domain Adaption by Transferring and Fusing Random Forest Models

NASA Astrophysics Data System (ADS)

Wu, J.; Yao, W.; Zhang, J.; Li, Y.

2018-04-01

Labeling 3D point cloud data with traditional supervised learning methods requires considerable labelled samples, the collection of which is cost and time expensive. This work focuses on adopting domain adaption concept to transfer existing trained random forest classifiers (based on source domain) to new data scenes (target domain), which aims at reducing the dependence of accurate 3D semantic labeling in point clouds on training samples from the new data scene. Firstly, two random forest classifiers were firstly trained with existing samples previously collected for other data. They were different from each other by using two different decision tree construction algorithms: C4.5 with information gain ratio and CART with Gini index. Secondly, four random forest classifiers adapted to the target domain are derived through transferring each tree in the source random forest models with two types of operations: structure expansion and reduction-SER and structure transfer-STRUT. Finally, points in target domain are labelled by fusing the four newly derived random forest classifiers using weights of evidence based fusion model. To validate our method, experimental analysis was conducted using 3 datasets: one is used as the source domain data (Vaihingen data for 3D Semantic Labelling); another two are used as the target domain data from two cities in China (Jinmen city and Dunhuang city). Overall accuracies of 85.5 % and 83.3 % for 3D labelling were achieved for Jinmen city and Dunhuang city data respectively, with only 1/3 newly labelled samples compared to the cases without domain adaption.

Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials

PubMed Central

Kaduszkiewicz, Hanna; Zimmermann, Thomas; Beck-Bornholdt, Hans-Peter; van den Bussche, Hendrik

2005-01-01

Objectives Pharmacological treatment of Alzheimer's disease focuses on correcting the cholinergic deficiency in the central nervous system with cholinesterase inhibitors. Three cholinesterase inhibitors are currently recommended: donepezil, rivastigmine, and galantamine. This review assessed the scientific evidence for the recommendation of these agents. Data sources The terms “donepezil”, “rivastigmine”, and “galantamine”, limited by “randomized-controlled-trials” were searched in Medline (1989-November 2004), Embase (1989-November 2004), and the Cochrane Database of Systematic Reviews without restriction for language. Study selection All published, double blind, randomised controlled trials examining efficacy on the basis of clinical outcomes, in which treatment with donepezil, rivastigmine, or galantamine was compared with placebo in patients with Alzheimer's disease, were included. Each study was assessed independently, following a predefined checklist of criteria of methodological quality. Results 22 trials met the inclusion criteria. Follow-up ranged from six weeks to three years. 12 of 14 studies measuring the cognitive outcome by means of the 70 point Alzheimer's disease assessment scale—cognitive subscale showed differences ranging from 1.5 points to 3.9 points in favour of the respective cholinesterase inhibitors. Benefits were also reported from all 12 trials that used the clinician's interview based impression of change scale with input from caregivers. Methodological assessment of all studies found considerable flaws—for example, multiple testing without correction for multiplicity or exclusion of patients after randomisation. Conclusion Because of flawed methods and small clinical benefits, the scientific basis for recommendations of cholinesterase inhibitors for the treatment of Alzheimer's disease is questionable. PMID:16081444

[The forgotten capitulation of evidence-based medicine].

PubMed

Schoemaker, Casper G; Smulders, Yvo M

2015-01-01

In 1992, the Canadian physician Gordon Guyatt wrote an article that is generally regarded as the starting point of evidence-based medicine (EBM). He described the ideas behind the McMaster residency programme for 'evidence-based practitioners', founded by David Sackett. Eight years later, in 2000, Guyatt concluded that this programme was too ambitious. In a new publication he described most doctors as 'evidence-users'. This editorial marks the transition from an individual to a collective form of EBM, emphasizing the use of evidence-based guidelines. The starting point of this collective form of EBM is not the well-known 1992 paper, but the forgotten editorial in 2000, which was described by Guyatt's colleagues as the capitulation of EBM.

EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice.

PubMed

Colebatch-Bourn, A N; Edwards, C J; Collado, P; D'Agostino, M-A; Hemke, R; Jousse-Joulin, S; Maas, M; Martini, A; Naredo, E; Østergaard, M; Rooney, M; Tzaribachev, N; van Rossum, M A; Vojinovic, J; Conaghan, P G; Malattia, C

2015-11-01

To develop evidence based points to consider the use of imaging in the diagnosis and management of juvenile idiopathic arthritis (JIA) in clinical practice. The task force comprised a group of paediatric rheumatologists, rheumatologists experienced in imaging, radiologists, methodologists and patients from nine countries. Eleven questions on imaging in JIA were generated using a process of discussion and consensus. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, scintigraphy and positron emission tomography. The experts used the evidence obtained from the relevant studies to develop a set of points to consider. The level of agreement with each point to consider was assessed using a numerical rating scale. A total of 13 277 references were identified from the search process, from which 204 studies were included in the systematic review. Nine points to consider were produced, taking into account the heterogeneity of JIA, the lack of normative data and consequent difficulty identifying pathology. These encompassed the role of imaging in making a diagnosis of JIA, detecting and monitoring inflammation and damage, predicting outcome and response to treatment, use of guided therapies, progression and remission. Level of agreement for each proposition varied according to the research evidence and expert opinion. Nine points to consider and a related research agenda for the role of imaging in the management of JIA were developed using published evidence and expert opinion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Addressing the Needs of Adolescents with Autism Spectrum Disorder: Considerations and Complexities for High School Interventions

ERIC Educational Resources Information Center

Kucharczyk, Suzanne; Reutebuch, Colleen K.; Carter, Erik W.; Hedges, Susan; El Zein, Farah; Gustafson, Jenny R.

2015-01-01

The outcomes of students with autism spectrum disorder (ASD) are driving the field to address how secondary education might be optimally designed and delivered. We conducted 28 focus groups across four states to explore the contexts, considerations, and complexities associated with delivering and combining evidence-based interventions to meet the…

Future Directions in Vulnerability to Depression among Youth: Integrating Risk Factors and Processes across Multiple Levels of Analysis

ERIC Educational Resources Information Center

Hankin, Benjamin L.

2012-01-01

Depression is a developmental phenomenon. Considerable progress has been made in describing the syndrome, establishing its prevalence and features, providing clues as to its etiology, and developing evidence-based treatment and prevention options. Despite considerable headway in distinct lines of vulnerability research, there is an explanatory gap…

Evidence for underuse of effective medical services around the world.

PubMed

Glasziou, Paul; Straus, Sharon; Brownlee, Shannon; Trevena, Lyndal; Dans, Leonila; Guyatt, Gordon; Elshaug, Adam G; Janett, Robert; Saini, Vikas

2017-07-08

Underuse-the failure to use effective and affordable medical interventions-is common and responsible for substantial suffering, disability, and loss of life worldwide. Underuse occurs at every point along the treatment continuum, from populations lacking access to health care to inadequate supply of medical resources and labour, slow or partial uptake of innovations, and patients not accessing or declining them. The extent of underuse for different interventions varies by country, and is documented in countries of high, middle, and low-income, and across different types of health-care systems, payment models, and health services. Most research into underuse has focused on measuring solutions to the problem, with considerably less attention paid to its global prevalence or its consequences for patients and populations. Although focused effort and resources can overcome specific underuse problems, comparatively little is spent on work to better understand and overcome the barriers to improved uptake of effective interventions, and methods to make them affordable. Copyright © 2017 Elsevier Ltd. All rights reserved.

Towards a Model of Technology Adoption: A Conceptual Model Proposition

NASA Astrophysics Data System (ADS)

Costello, Pat; Moreton, Rob

A conceptual model for Information Communication Technology (ICT) adoption by Small Medium Enterprises (SMEs) is proposed. The research uses several ICT adoption models as its basis with theoretical underpinning provided by the Diffusion of Innovation theory and the Technology Acceptance Model (TAM). Taking an exploratory research approach the model was investigated amongst 200 SMEs whose core business is ICT. Evidence from this study demonstrates that these SMEs face the same issues as all other industry sectors. This work points out weaknesses in SMEs environments regarding ICT adoption and suggests what they may need to do to increase the success rate of any proposed adoption. The methodology for development of the framework is described and recommendations made for improved Government-led ICT adoption initiatives. Application of the general methodology has resulted in new opportunities to embed the ethos and culture surrounding the issues into the framework of new projects developed as a result of Government intervention. A conceptual model is proposed that may lead to a deeper understanding of the issues under consideration.

On the systematics in apparent proper motions of radio sources observed by VLBI

NASA Astrophysics Data System (ADS)

Raposo-Pulido, V.; Lambert, S.; Capitaine, N.; Nilsson, T.; Heinkelmann, R.; Schuh, H.

2015-08-01

For about twenty years, several authors have been investigating the systematics in the apparent proper motions of radio source positions. In some cases, the theoretical work developed (Pyne et al., 1996) could not be assessed due to the few number of VLBI observations. In other cases, the effects attributed to apparent proper motion could not be related successfully because there were no significant evidences from a statistical point of view (MacMillan, 2005). In this work we provide considerations about the estimation of the coefficients of spherical harmonics, based on a three-step procedure used by Titov et al. (2011) and Titov and Lambert (2013). The early stage of this work has been to compare step by step the computations and estimation processes between the Calc/Solve (http://gemini.gsfc.nasa.gov/solve/) and VieVS software (Böhm et al., 2012). To achieve this, the results were analyzed and compared with the previous study done by Titov and Lambert (2013).

Transcriptional noise in intact and TGF-beta treated human kidney cells; the importance of time-series designs.

PubMed

Rabieian, Reyhaneh; Moein, Shiva; Khanahmad, Hossein; Mortazavi, Mojgan; Gheisari, Yousof

2018-05-26

The transforming growth factor (TGF)-β signaling pathway plays a key role in various cellular processes. However, insufficient knowledge about the complex and sometimes paradoxical functions of this pathway hinders its therapeutic targeting. In this study, the transcriptional profile of seven mediators and downstream elements of the TGF-β pathway were assessed in TGF-β treated and untreated human kidney derived cells for 2 weeks in a time course manner. As expected the up-regulation of ACTA2 and COL1A2 was evident in the treated cells. However, we observed remarkable fluctuations in gene expression, even in the supposedly steady states. The magnitude of noise was diverse in the examined genes. Our findings underscore the significance of time-course designs for gene expression analyses and clearly show that misleading data can be obtained in single point measurements. Furthermore, we propose specific considerations in the interpretation of time-course data in the context of noisy gene expression. © 2018 International Federation for Cell Biology.

Surveillance for outbreaks of influenza-like illness in the institutionalized elderly.

PubMed

Rosewell, A; Chiu, C; Lindley, R; Dwyer, D E; Moffatt, C R M; Shineberg, C; Clarke, E; Booy, R; MacIntyre, C R

2010-08-01

Respiratory outbreaks are common in aged-care facilities (ACFs), are both underreported and frequently identified late, and are often associated with considerable burden of illness and death. There is emerging evidence that active surveillance coupled with early and systematic intervention can reduce this burden. Active surveillance for influenza-like illness and rapid diagnosis of influenza were established in 16 ACFs in Sydney, Australia, prior to the winter of 2006. A point-of-care influenza test and laboratory direct immunofluorescence tests for common respiratory viruses were used for diagnosis. We achieved early identification of seven respiratory disease outbreaks, two of which were caused by influenza. For the influenza outbreaks, antiviral treatment and prophylaxis were initiated 4-6 days from symptom onset in the primary case. A simple active surveillance system for influenza was successfully implemented and resulted in early detection of influenza and other respiratory disease outbreaks. This enabled earlier implementation of prevention and control measures and increased the potential effectiveness of anti-influenza chemoprophylaxis.

Exercising our brains: how physical activity impacts synaptic plasticity in the dentate gyrus.

PubMed

Christie, Brian R; Eadie, Brennan D; Kannangara, Timal S; Robillard, Julie M; Shin, James; Titterness, Andrea K

2008-01-01

Exercise that engages the cardiovascular system has a myriad of effects on the body; however, we usually do not give much consideration to the benefits it may have for our minds. An increasing body of evidence suggests that exercise can have some remarkable effects on the brain. In this article, we will introduce how exercise can impact the capacity for neurons in the brain to communicate with one another. To properly convey this information, we will first briefly introduce the field of synaptic plasticity and then examine how the introduction of exercise to the experimental setting can actually alter the basic properties of synaptic plasticity in the brain. Next, we will examine some of the candidate physiological processes that might underlay these alterations. Finally, we will close by noting that, taken together, this data points toward our brains being dynamic systems that are in a continual state of flux and that physical exercise may help us to maximize the performance of both our body and our minds.

Trends and Divergences in Childhood Income Dynamics, 1970-2010.

PubMed

Hill, Heather D

2018-01-01

Earnings and income variability have increased since the 1970s, particularly at the bottom of the income distribution. Considerable evidence suggests that childhood income levels-captured as average or point-in-time yearly income-are associated with numerous child and adult outcomes. The importance to child development of stable proximal processes during childhood suggests that income variability may also be important, particularly if it is unpredictable, unintentional, or does not reflect an upward trend in family income. Using the Panel Study of Income Dynamics, this study documents trends since the 1970s in three dimensions of childhood income dynamics: level, variability, and growth (n=7991). The analysis reveals that income variability during childhood has grown over time, while income growth rates have not. In addition, the economic context of childhood has diverged substantially by socioeconomic status, race, and family structure, with the most disadvantaged children facing a double-whammy of low income and high variability. © 2018 Elsevier Inc. All rights reserved.

Late-Life Decline in Well-Being Across Adulthood in Germany, the UK, and the US: Something is Seriously Wrong at the End of Life

PubMed Central

Gerstorf, Denis; Ram, Nilam; Mayraz, Guy; Hidajat, Mira; Lindenberger, Ulman; Wagner, Gert G.; Schupp, Jürgen

2010-01-01

Throughout adulthood and old age, levels of well-being appear to remain relatively stable. However, evidence is emerging that late in life well-being declines considerably. Using long-term longitudinal data of deceased participants in national samples from Germany, the UK, and the US, we examine how long this period lasts. In all three nations and across the adult age range, well-being was relatively stable over age, but declined rapidly with impending death. Articulating notions of terminal decline associated with impending death, we identified prototypical transition points in each study between three and five years prior to death, after which normative rates of decline steepened by a factor of three or more. The findings suggest that mortality-related mechanisms drive late-life changes in well-being and highlight the need for further refinement of psychological concepts about how and when late-life declines in psychosocial functioning prototypically begin. PMID:20545432

Training in surgical oncology - the role of VR simulation.

PubMed

Lewis, T M; Aggarwal, R; Rajaretnam, N; Grantcharov, T P; Darzi, A

2011-09-01

There have been dramatic changes in surgical training over the past two decades which have resulted in a number of concerns for the development of future surgeons. Changes in the structure of cancer services, working hour restrictions and a commitment to patient safety has led to a reduction in training opportunities that are available to the surgeon in training. Simulation and in particular virtual reality (VR) simulation has been heralded as an effective adjunct to surgical training. Advances in VR simulation has allowed trainees to practice realistic full length procedures in a safe and controlled environment, where mistakes are permitted and can be used as learning points. There is considerable evidence to demonstrate that the VR simulation can be used to enhance technical skills and improve operating room performance. Future work should focus on the cost effectiveness and predictive validity of VR simulation, which in turn would increase the uptake of simulation and enhance surgical training. Copyright © 2011 Elsevier Ltd. All rights reserved.

Genetic and environmental contributions to children's prosocial behavior: brief review and new evidence from a reanalysis of experimental twin data.

PubMed

Knafo-Noam, Ariel; Vertsberger, Dana; Israel, Salomon

2018-04-01

Children's prosocial behaviors show considerable variability. Here we discuss the genetic and environmental contributions to individual differences in children's prosocial behavior. Twin research systematically shows, at least from the age of 3 years, a genetic contribution to individual differences in prosocial behavior, both questionnaire-based and observed. This finding is demonstrated across a wide variety of cultures. We discuss the possibility that different prosocial behaviors have different genetic etiologies. A re-analysis of past twin data shows that sharing and comforting are affected by overlapping genetic factors at age 3.5 years. In contrast, the association between helping and comforting is attributed to environmental factors. The few molecular genetic studies of children's prosocial behavior are reviewed, and we point out genome-wide and polygenic methods as a key future direction. Finally, we discuss the interplay of genetic and environmental factors, focusing on both gene×environment interactions and gene-environment correlations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Does acceptance of power distance influence propensities for problematic Internet use? Evidence from a cross-cultural study.

PubMed

Montag, Christian; Duke, Éilish; Sha, Peng; Zhou, Min; Sindermann, Cornelia; Li, Mei

2016-12-01

Several studies suggest that Asian countries are particularly afflicted by problematic Internet use (PIU). The present study investigates whether individual differences in the acceptance of power distance can be linked to overuse of the Internet in Germany and in China. Power distance has been discussed as an essential dimension on which Asian and Western societies differ. In the present study, we investigate two large non-clinical samples from Germany (n = 297) and China (n = 556) to address this question. Both in Germany and in China, high acceptance of power distance was positively associated with PIU. These effects were more pronounced in China compared with Germany. Moreover, the observed effects were stronger in males compared with females. Clearly, these findings are just a starting point and need to be replicated in the future. Clinical populations and a further important difference variable - collectivism - also merit consideration in future work. © 2015 Wiley Publishing Asia Pty Ltd.

Potential of the Trad-MCN assay applied with inflorescences of Tradescantia pallida 'Purpurea' for evaluating air contamination by naphthalene.

PubMed

Alves, Edenise Segala; de Souza, Silvia Ribeiro; Pedroso, Andrea Nunes Vaz; Domingos, Marisa

2008-11-01

The aims of this study were to determine clastogenic responses of Tradescantia pallida cv. Purpurea to naphthalene (NAPH) by means of the bioassay Trad-MCN with inflorescences of T. pallida cv. Purpurea and to verify if this assay might be an indicator of the potential risk imposed in a workplace, where solid insecticide containing NAPH is usually applied. The clastogenic potential of NAPH was assessed by using static and dynamic experimental systems. In both systems, increased micronucleus frequencies were observed in inflorescences submitted to increasing concentrations of solid or gaseous NAPH. The evident clastogenicity verified in inflorescences exposed experimentally to 25-50 mg m(-3) of NAPH during 6h points to a narrow threshold of plant sensitivity, indicating risks under lower NAPH levels than the standards established by OSHA and therefore revealing its suitability for biomonitoring purposes. However, the clastogenic risk should be carefully investigated by other monitoring methods if human health is taken into consideration.

Early Mars was wet but not warm: Erosion, fluvial features, liquid water habitats, and life below freezing

NASA Technical Reports Server (NTRS)

Mckay, C. P.; Davis, W. L.

1993-01-01

There is considerable evidence that Mars had liquid water early in its history and possibly at recurrent interval. It has generally been assumed that this implied that the climate was warmer as a result of a thicker CO2 atmosphere than at the present. However, recent models suggest that Mars may have had a thick atmosphere but may not have experienced mean annual temperatures above freezing. In this paper we report on models of liquid water formation and maintenance under temperatures well below freezing. Our studies are based on work in the north and south polar regions of Earth. Our results suggest that early Mars did have a thick atmosphere but precipitation and hence erosion was rare. Transient liquid water, formed under temperature extremes and maintained under thick ice covers, could account for the observed fluvial features. The main difference between the present climate and the early climate was that the total surface pressure was well above the triple point of water.

A mixed state core for melancholia: an exploration in history, art and clinical science.

PubMed

Akiskal, H S; Akiskal, K K

2007-01-01

We argue for a mixed state core for melancholia comparing concepts of melancholia across centuries using examples from art, history and scientific literature. Literature reviews focusing on studies from Kraepelin onward, DSM-IV classification and view-points from clinical experience highlighting phenomenologic and biologic features as predictors of bipolar outcome in prospective studies of depression. Despite the implied chemical pathology in the term endogenous/melancholic depression, frequently reported glucocortical and sleep neurophysiologic abnormalities, there is little evidence that melancholia is inherited independently from more broadly defined depressions. Prospective follow-up of 'neurotic' depressions have shown melancholic outcomes in as many as a third; hypomania has also been observed in such follow-up. These findings and considerations overall do suggest that melancholia as defined today is more closely aligned with the depressive and/or mixed phase of bipolar disorder. Given the high suicidality from many of these patients the practice of treating them with antidepressant monotherapy needs re-evaluation.

A cholinergic feedback circuit to regulate striatal population uncertainty and optimize reinforcement learning

PubMed Central

Franklin, Nicholas T; Frank, Michael J

2015-01-01

Convergent evidence suggests that the basal ganglia support reinforcement learning by adjusting action values according to reward prediction errors. However, adaptive behavior in stochastic environments requires the consideration of uncertainty to dynamically adjust the learning rate. We consider how cholinergic tonically active interneurons (TANs) may endow the striatum with such a mechanism in computational models spanning three Marr's levels of analysis. In the neural model, TANs modulate the excitability of spiny neurons, their population response to reinforcement, and hence the effective learning rate. Long TAN pauses facilitated robustness to spurious outcomes by increasing divergence in synaptic weights between neurons coding for alternative action values, whereas short TAN pauses facilitated stochastic behavior but increased responsiveness to change-points in outcome contingencies. A feedback control system allowed TAN pauses to be dynamically modulated by uncertainty across the spiny neuron population, allowing the system to self-tune and optimize performance across stochastic environments. DOI: http://dx.doi.org/10.7554/eLife.12029.001 PMID:26705698

Lattice QCD evidence that the Λ(1405) resonance is an antikaon-nucleon molecule.

PubMed

Hall, Jonathan M M; Kamleh, Waseem; Leinweber, Derek B; Menadue, Benjamin J; Owen, Benjamin J; Thomas, Anthony W; Young, Ross D

2015-04-03

For almost 50 years the structure of the Λ(1405) resonance has been a mystery. Even though it contains a heavy strange quark and has odd parity, its mass is lower than any other excited spin-1/2 baryon. Dalitz and co-workers speculated that it might be a molecular state of an antikaon bound to a nucleon. However, a standard quark-model structure is also admissible. Although the intervening years have seen considerable effort, there has been no convincing resolution. Here we present a new lattice QCD simulation showing that the strange magnetic form factor of the Λ(1405) vanishes, signaling the formation of an antikaon-nucleon molecule. Together with a Hamiltonian effective-field-theory model analysis of the lattice QCD energy levels, this strongly suggests that the structure is dominated by a bound antikaon-nucleon component. This result clarifies that not all states occurring in nature can be described within a simple quark model framework and points to the existence of exotic molecular meson-nucleon bound states.

[Rehabilitation of a periodontally compromised dentition with implant-supported zirconia bridges. Case report].

PubMed

Balmer, Sacha; Mericske-Stern, Regina

2009-01-01

Clinical aspects of reconstruction with fix prosthesis and dental implants in a patient with a history of periodontitis is shown. A successful stabilization and rehabilitation of the periodontally involved dentition can be achieved with tooth-worn crown and bridge reconstructions. From a functional and aesthetic point of view the result may not be satisfying due to mobility and overlength of the teeth and open approximal spaces. Today, dentist and patient have often to weigh if teeth shall be maintained or replaced by dental implants. Thereby, both must be aware of the fact that in complex cases long-term success and aesthetic outcome may be difficult to predict. An intense discussion with the patient on his expectations, invasive treatment, risks with regard to biologic and prosthetic aspects is mandatory and must be based on the best scientific evidence available. The present case report shows different considerations and describes a radical solution which meets the patient's needs and is based on modern CAD-CAM technology.

[Fluctuant pulmonary nodules as presentation of a MALT lymphoma].

PubMed

Dolz Aspas, R; Toyas Miazza, C; Ruiz Ruiz, F; Morales Rull, J L; Pérez Calvo, J I

2003-11-01

Mucosa associated lymphoid tissue (MALT) lymphomas are a group of non- Hodgkin"s lymphomas of low malignancy degree. The most frequent location is the gastrointestinal tract. Its primary pulmonary presentation is unusual and heterogeneous from point of view radiological. Woman 61 years old with antecedents of vitiligo, gastric ulcus, cirrhosis by VHC, that go into the hospital by sudden disnea, thoracic paint with pleural characterises and fever of 38.5 degrees C, Her thorax radiography and thoracic TAC showed nodes that affect to different pulmonary lobes. The cytology by PAAF confirms their malignant nature. In subsequent radiological controls it was notice the nodels took away completely and returns in different pulmonary place in each recurrence. The presentation like fluctuant pulmonary nodes is exceptional in a MALT lymphoma. It was described a higher incidence of VHC infection and tumour. The evidence of chronic hepatitis by virus C disease, and local chronic inflammatory process as well as autoimmune disorders may be considerate like a factor that contribute to MALT lymphoma.

Concentrations of Environmental Phenols and Parabens in Milk, Urine and Serum of Lactating North Carolina Women

PubMed Central

Hines, Erin P.; Mendola, Pauline; vonEhrenstein, Ondine S.; Ye, Xiaoyun; Calafat, Antonia M.; Fenton, Suzanne E.

2015-01-01

Phenols and parabens show some evidence for endocrine disruption in laboratory animals. The goal of the Methods Advancement for Milk Analysis (MAMA) Study was to develop or adapt methods to measure parabens (methyl, ethyl, butyl, propyl) and phenols (bisphenol A (BPA), 2,4- and 2,5-dichlorophenol, benzophenone-3, triclosan) in urine, milk and serum twice during lactation, to compare concentrations across matrices and with endogenous biomarkers among 34 North Carolina women. These non-persistent chemicals were detected in most urine samples (53-100%) and less frequently in milk or serum; concentrations differed by matrix. Although urinary parabens, triclosan and dichlorophenols concentrations correlated significantly at two time points, those of BPA and benzophenone-3 did not, suggesting considerable variability in those exposures. These pilot data suggest that nursing mothers are exposed to phenols and parabens; urine is the best measurement matrix; and correlations between chemical and endogenous immune-related biomarkers merit further investigation. PMID:25463527

Sex differences in impulsive action and impulsive choice.

PubMed

Weafer, Jessica; de Wit, Harriet

2014-11-01

Here, we review the evidence for sex differences in behavioral measures of impulsivity for both humans and laboratory animals. We focus on two specific components of impulsivity: impulsive action (i.e., difficulty inhibiting a prepotent response) and impulsive choice (i.e., difficulty delaying gratification). Sex differences appear to exist on these measures, but the direction and magnitude of the differences vary. In laboratory animals, impulsive action is typically greater in males than females, whereas impulsive choice is typically greater in females. In humans, women discount more steeply than men, but sex differences on measures of impulsive action depend on tasks and subject samples. We discuss implications of these findings as they relate to drug addiction. We also point out the major gaps in this research to date, including the lack of studies designed specifically to examine sex differences in behavioral impulsivity, and the lack of consideration of menstrual or estrous phase or sex hormone levels in the studies. © 2013.

Sex differences in impulsive action and impulsive choice

PubMed Central

Weafer, Jessica; de Wit, Harriet

2013-01-01

Here, we review the evidence for sex differences in behavioral measures of impulsivity for both humans and laboratory animals. We focus on two specific components of impulsivity: impulsive action (i.e., difficulty inhibiting a prepotent response) and impulsive choice (i.e., difficulty delaying gratification). Sex differences appear to exist on these measures, but the direction and magnitude of the differences vary. In laboratory animals, impulsive action is typically greater in males than females, whereas impulsive choice is typically greater in females. In humans, women discount more steeply than men, but sex differences on measures of impulsive action depend on tasks and subject samples. We discuss implications of these findings as they relate to drug addiction. We also point out the major gaps in this research to date, including the lack of studies designed specifically to examine sex differences in behavioral impulsivity, and the lack of consideration of menstrual or estrous phase or sex hormone levels in the studies. PMID:24286704

Sex uncovered special issue: The ecology of sexual reproduction

PubMed Central

LIVELY, C. M.; MORRAN, L. T.

2014-01-01

Sexual reproduction is widely regarded as one of the major unexplained phenomena in biology. Nonetheless, while a general answer may remain elusive, considerable progress has been made in the last few decades. Here we fist review the genesis of, and support for, the major ecological hypotheses for biparental sexual reproduction. We then focus on the idea that host-parasite coevolution can favor cross fertilization over uniparental forms of reproduction, as this hypothesis currently has the most support from natural populations. We also review the results from experimental evolution studies, which tend to show that exposure to novel environments can select for higher levels of sexual reproduction, but that sex decreases in frequency after populations become adapted to the previously novel conditions. In contrast, experimental coevolution studies suggest that host-parasite interactions can lead to the long-term persistence of sex. Taken together, the evidence from natural populations and from laboratory experiments point to antagonistic coevolution as a potent and possibly ubiquitous force of selection favoring cross-fertilization and recombination. PMID:24617324

Mechanisms of chronic pain - key considerations for appropriate physical therapy management.

PubMed

Courtney, Carol A; Fernández-de-Las-Peñas, César; Bond, Samantha

2017-07-01

In last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes. In fact, almost any patient suffering with a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological. This rational has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management. The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain.

Perspectives on African Ozone from Sondes, Dobson and Aircraft Measurements

NASA Technical Reports Server (NTRS)

Thompson, A. M.; Witte, J. C.; Chatfield, R. B.; Diab, R. D.; Thouret, V.; Sauvage, B.

2004-01-01

We have been studying variability in ozone over Africa using data from ozonesondes (vertical profiles from surface to stratosphere), aircraft (the MOZAIC dataset with cruise altitude and landing/takeoff profiles) and the ground (Dobson spectrophotometer total ozone column measurement). The following may give context for ozone investigations during AMMA: 1. Total ozone measurements since 1989 show considerable variability in mean value among the African stations in Algeria, Kenya, Egypt, South Africa, as well as in seasonal cycles and year-to-year. Trends are not evident. 2. The impacts of convection, stratospheric injection, biomass burning and lightning appear in ozone sounding profile data. Time-series analysis and case studies point to periodic influences of long-range interactions with the Atlantic ("ozone paradox," wave-one") and Indian Oceans. 3. Tropospheric ozone variations, observed in tropospheric profiles and integrated column amount, follow general seasonal patterns but short- term variability is so strong that simple averages are inadequate for describing "climatology" and statistical classification approaches may be required.

Controversies in office based anesthesia: obstructive sleep apnea considerations.

PubMed

Gupta, Ruchir; Pyati, Srinivas

2018-05-14

As the number of procedures being performed in the office based anesthesia (OBA) setting are increasing, so are the number of patients presenting for surgery with obstructive sleep apnea (OSA). There continues to be controversy regarding whether these patients can be safely cared for in the OBA setting. To date, no national guideline has clearly addressed this issue and while some have extrapolated lessons from what has been published for OSA in the ambulatory surgery center (ASC) setting, some argue that there is a significant difference in the availability of resources in the ASC versus the OBA setting. Those opposing OSA patients for OBA setting point to the prevalence of "practice drift," and no federal oversight as overarching reasons why the OBA is not an appropriate setting. Proponents of the OBA setting argue that a well equipped OBA can have similar resources, and therefore similar outcomes, as an OR in the ASC setting. In this paper we explore the divergent views on this topic and present some recommendations based on best evidence.

Biology of diesel exhaust effects on respiratory function.

PubMed

Riedl, Marc; Diaz-Sanchez, David

2005-02-01

In recent decades, clinicians and scientists have witnessed a significant increase in the prevalence of allergic rhinitis and asthma. The factors underlying this phenomenon are clearly complex; however, this rapid increase in the burden of atopic disease has undeniably occurred in parallel with rapid industrialization and urbanization in many parts of the world. Consequently, more people are exposed to air pollutants than at any point in human history. Worldwide, increases in allergic respiratory disease have mainly been observed in urban communities. Epidemiologic and clinical investigations have suggested a strong link between particulate air pollution and detrimental health effects, including cardiopulmonary morbidity and mortality. The purpose of this review is to provide an evidence-based summary of the health effects of air pollutants on asthma, focusing on diesel exhaust particles (DEPs) as a model particulate air pollutant. An overview of observational and experimental studies linking DEPs and asthma will be provided, followed by consideration of the mechanisms underlying DEP-induced inflammation and a brief discussion of future research and clinical directions.

Multiferroicity in an organic charge-transfer salt that is suggestive of electric-dipole-driven magnetism

NASA Astrophysics Data System (ADS)

Lunkenheimer, Peter; Müller, Jens; Krohns, Stephan; Schrettle, Florian; Loidl, Alois; Hartmann, Benedikt; Rommel, Robert; de Souza, Mariano; Hotta, Chisa; Schlueter, John A.; Lang, Michael

2012-09-01

Multiferroics, showing simultaneous ordering of electrical and magnetic degrees of freedom, are remarkable materials as seen from both the academic and technological points of view. A prominent mechanism of multiferroicity is the spin-driven ferroelectricity, often found in frustrated antiferromagnets with helical spin order. There, as for conventional ferroelectrics, the electrical dipoles arise from an off-centre displacement of ions. However, recently a different mechanism, namely purely electronic ferroelectricity, where charge order breaks inversion symmetry, has attracted considerable interest. Here we provide evidence for ferroelectricity, accompanied by antiferromagnetic spin order, in a two-dimensional organic charge-transfer salt, thus representing a new class of multiferroics. We propose a charge-order-driven mechanism leading to electronic ferroelectricity in this material. Quite unexpectedly for electronic ferroelectrics, dipolar and spin order arise nearly simultaneously. This can be ascribed to the loss of spin frustration induced by the ferroelectric ordering. Hence, here the spin order is driven by the ferroelectricity, in marked contrast to the spin-driven ferroelectricity in helical magnets.

A change in the optical polarization associated with a gamma-ray flare in the blazar 3C 279.

PubMed

2010-02-18

It is widely accepted that strong and variable radiation detected over all accessible energy bands in a number of active galaxies arises from a relativistic, Doppler-boosted jet pointing close to our line of sight. The size of the emitting zone and the location of this region relative to the central supermassive black hole are, however, poorly known, with estimates ranging from light-hours to a light-year or more. Here we report the coincidence of a gamma (gamma)-ray flare with a dramatic change of optical polarization angle. This provides evidence for co-spatiality of optical and gamma-ray emission regions and indicates a highly ordered jet magnetic field. The results also require a non-axisymmetric structure of the emission zone, implying a curved trajectory for the emitting material within the jet, with the dissipation region located at a considerable distance from the black hole, at about 10(5) gravitational radii.

A change in the optical polarization associated with a γ-ray flare in the blazar 3C279

DOE PAGES

Abdo, A. A.; Ackermann, M.; Ajello, M.; ...

2010-02-18

It is widely accepted that strong and variable radiation detected over all accessible energy bands in a number of active galaxies arises from a relativistic, Doppler-boosted jet pointing close to our line of sight1. Furthermore, the size of the emitting zone and the location of this region relative to the central supermassive black hole are, however, poorly known, with estimates ranging from light-hours to a light-year or more. We report the coincidence of a gamma (γ)-ray flare with a dramatic change of optical polarization angle. This provides evidence for co-spatiality of optical and γ-ray emission regions and indicates a highlymore » ordered jet magnetic field. Our results also require a non-axisymmetric structure of the emission zone, implying a curved trajectory for the emitting material within the jet, with the dissipation region located at a considerable distance from the black hole, at about 105 gravitational radii.« less

Temperament, Speech and Language: An Overview

ERIC Educational Resources Information Center

Conture, Edward G.; Kelly, Ellen M.; Walden, Tedra A.

2013-01-01

The purpose of this article is to discuss definitional and measurement issues as well as empirical evidence regarding temperament, especially with regard to children's (a)typical speech and language development. Although all ages are considered, there is a predominant focus on children. Evidence from considerable empirical research lends support…

Peer Victimization and Depression in Early-Mid Adolescence: A Longitudinal Study

ERIC Educational Resources Information Center

Sweeting, Helen; Young, Robert; West, Patrick; Der, Geoff

2006-01-01

Background: Despite considerable evidence for psychological distress among children and young people who experience peer victimization, cross-sectional studies cannot determine the direction of the relationship. Several recent studies have examined associations between victimization and distress. The majority find evidence for both directions but…

The Use of Prompting as an Evidence-Based Strategy to Support Children with ASD in School Settings in New Zealand

ERIC Educational Resources Information Center

Hayes, Dervla

2013-01-01

This article examines the use of prompting as an evidence-based strategy to support children with autism to develop their language, communication and social interactions skills. The literature is reviewed using a three-ringed, evidence-based practice model to support evaluation of the use of prompting. The article outlines considerations about the…

34 CFR 75.266 - What procedures does the Secretary use if the Secretary decides to give special consideration to...

Code of Federal Regulations, 2014 CFR

2014-07-01

... the procedures in 34 CFR 75.105(c)(3), or provide competitive preference under the procedures in 34 CFR 75.105(c)(2), for applications supported by: (1) Evidence of effectiveness that meets the... definition of “strong evidence of effectiveness” in 34 CFR 77.1; or (3) Evidence of effectiveness that meets...

Surface Charge Development on Transition Metal Sulfides: An Electrokinetic Study

NASA Astrophysics Data System (ADS)

Bebie, Joakim; Schoonen, Martin A. A.; Fuhrmann, Mark; Strongin, Daniel R.

1998-02-01

The isoelectric points, pH i.e.p., of ZnS, PbS, CuFeS 2, FeS, FeS 2, NiS 2, CoS 2, and MnS 2 in NaCl supported electrolyte solutions are estimated to be between pH 3.3 and 0.6, with most of the isoelectric points below pH 2. The first electrokinetic measurements on NiS 2, CoS 2, and MnS 2 are reported here. Below pH i.e.p. the metal-sulfide surfaces are positively charged, above pH i.e.p. the surfaces are negatively charged. The addition of Me 2+ ions shifts the pH i.e.p. and changes the pH dependence considerably. The isoelectric points of the measured transition metal sulfides in the absence of metal ions or dissolved sulfide (H 2S or HS -) are in agreement with those found in earlier studies. The pH range of observed isoelectric points for metal sulfides (0.6-3.3) is compared to the considerably wider pH i.e.p. range (2-12) found for oxides. The correlation between pH i.e.p. and the electronegativities of the metal sulfides suggests that all metal sulfides will have an isoelectric point between pH 0.6 and 3.3. Compared to metal oxides, sulfides exhibit an isoelectric point that is largely independent of the nature of the metal cation in the solid.

Stress analysis and design considerations for Shuttle pointed autonomous research tool for astronomy /SPARTAN/

NASA Technical Reports Server (NTRS)

Ferragut, N. J.

1982-01-01

The Shuttle Pointed Autonomous Research Tool for Astronomy (SPARTAN) family of spacecraft are intended to operate with minimum interfaces with the U.S. Space Shuttle in order to increase flight opportunities. The SPARTAN I Spacecraft was designed to enhance structural capabilities and increase reliability. The approach followed results from work experience which evolved from sounding rocket projects. Structural models were developed to do the analyses necessary to satisfy safety requirements for Shuttle hardware. A loads analysis must also be performed. Stress analysis calculations will be performed on the main structural elements and subcomponents. Attention is given to design considerations and program definition, the schematic representation of a finite element model used for SPARTAN I spacecraft, details of loads analysis, the stress analysis, and fracture mechanics plan implications.

Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data.

PubMed

Waldinger, Marcel D; Zwinderman, Aeilko H; Olivier, Berend; Schweitzer, Dave H

2005-07-01

Consensus on a definition of premature ejaculation has not yet been reached because of debates based on subjective authority opinions and nonstandardized assessment methods to measure ejaculation time and ejaculation control. To provide a definition for lifelong premature ejaculation that is based on epidemiological evidence including the neurobiological and psychological approach. We used the 0.5 and 2.5 percentiles as accepted standards of disease definition in a skewed distribution. We applied these percentiles in a stopwatch-determined intravaginal ejaculation latency time (IELT) distribution of 491 nonselected men from five different countries. The practical consequences of 0.5% and 2.5% cutoff points for disease definition were taken into consideration by reviewing current knowledge of feelings of control and satisfaction in relation to ejaculatory performance of the general male population. Literature arguments to be used in a proposed consensus on a definition of premature ejaculation. The stopwatch-determined IELT distribution is positively skewed. The 0.5 percentile equates to an IELT of 0.9 minute and the 2.5 percentile an IELT of 1.3 minutes. However, there are no available data in the literature on feelings of control or satisfaction in relation to ejaculatory latency time in the general male population. Random male cohort studies are needed to end all speculation on this subject. Exact stopwatch time assessment of IELT in a multinational study led us to propose that all men with an IELT of less than 1 minute (belonging to the 0.5 percentile) have "definite" premature ejaculation, while men with IELTs between 1 and 1.5 minutes (between 0.5 and 2.5 percentile) have "probable" premature ejaculation. Severity of premature ejaculation (nonsymptomatic, mild, moderate, severe) should be defined in terms of associated psychological problems. We define lifelong premature ejaculation as a neurobiological dysfunction with an unacceptable increase of risk to develop sexual and psychological problems anywhere in a lifetime. By defining premature ejaculation from an authority-defined disorder into a dysfunction based on epidemiological evidence it is possible to establish consensus based on epidemiological evidence. Additional epidemiological stopwatch studies are needed for a final decision of IELT values at both percentile cutoff points.

What implementation interventions increase cancer screening rates? a systematic review

PubMed Central

2011-01-01

Background Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests. Methods Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo. Results The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions. Conclusion The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research. PMID:21958556

Dietary supplements for dysmenorrhoea.

PubMed

Pattanittum, Porjai; Kunyanone, Naowarat; Brown, Julie; Sangkomkamhang, Ussanee S; Barnes, Joanne; Seyfoddin, Vahid; Marjoribanks, Jane

2016-03-22

Dysmenorrhoea refers to painful menstrual cramps and is a common gynaecological complaint. Conventional treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which both reduce myometrial activity (contractions of the uterus). A suggested alternative approach is dietary supplements. We used the term 'dietary supplement' to include herbs or other botanical, vitamins, minerals, enzymes, and amino acids. We excluded traditional Chinese medicines. To determine the efficacy and safety of dietary supplements for treating dysmenorrhoea. We searched sources including the Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO (all from inception to 23 March 2015), trial registries, and the reference lists of relevant articles. We included randomised controlled trials (RCTs) of dietary supplements for moderate or severe primary or secondary dysmenorrhoea. We excluded studies of women with an intrauterine device. Eligible comparators were other dietary supplements, placebo, no treatment, or conventional analgesia. Two review authors independently performed study selection, performed data extraction and assessed the risk of bias in the included trials. The primary outcomes were pain intensity and adverse effects. We used a fixed-effect model to calculate odds ratios (ORs) for dichotomous data, and mean differences (MDs) or standardised mean differences (SMDs) for continuous data, with 95% confidence intervals (CIs). We presented data that were unsuitable for analysis either descriptively or in additional tables. We assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. We included 27 RCTs (3101 women). Most included studies were conducted amongst cohorts of students with primary dysmenorrhoea in their late teens or early twenties. Twenty-two studies were conducted in Iran and the rest were performed in other middle-income countries. Only one study addressed secondary dysmenorrhoea. Interventions included 12 different herbal medicines (German chamomile (Matricaria chamomilla, M recutita, Chamomilla recutita), cinnamon (Cinnamomum zeylanicum, C. verum), Damask rose (Rosa damascena), dill (Anethum graveolens), fennel (Foeniculum vulgare), fenugreek (Trigonella foenum-graecum), ginger (Zingiber officinale), guava (Psidium guajava), rhubarb (Rheum emodi), uzara (Xysmalobium undulatum), valerian (Valeriana officinalis), and zataria (Zataria multiflora)) and five non-herbal supplements (fish oil, melatonin, vitamins B1 and E, and zinc sulphate) in a variety of formulations and doses. Comparators included other supplements, placebo, no treatment, and NSAIDs.We judged all the evidence to be of low or very low quality. The main limitations were imprecision due to very small sample sizes, failure to report study methods, and inconsistency. For most comparisons there was only one included study, and very few studies reported adverse effects. Effectiveness of supplements for primary dysmenorrhoea We have presented pain scores (all on a visual analogue scale (VAS) 0 to 10 point scale) or rates of pain relief, or both, at the first post-treatment follow-up. Supplements versus placebo or no treatmentThere was no evidence of effectiveness for vitamin E (MD 0.00 points, 95% CI -0.34 to 0.34; two RCTs, 135 women).There was no consistent evidence of effectiveness for dill (MD -1.15 points, 95% CI -2.22 to -0.08, one RCT, 46 women), guava (MD 0.59, 95% CI -0.13 to 1.31; one RCT, 151 women); one RCT, 73 women), or fennel (MD -0.34 points, 95% CI -0.74 to 0.06; one RCT, 43 women).There was very limited evidence of effectiveness for fenugreek (MD -1.71 points, 95% CI -2.35 to -1.07; one RCT, 101 women), fish oil (MD 1.11 points, 95% CI 0.45 to 1.77; one RCT, 120 women), fish oil plus vitamin B1 (MD -1.21 points, 95% CI -1.79 to -0.63; one RCT, 120 women), ginger (MD -1.55 points, 95% CI -2.43 to -0.68; three RCTs, 266 women; OR 5.44, 95% CI 1.80 to 16.46; one RCT, 69 women), valerian (MD -0.76 points, 95% CI -1.44 to -0.08; one RCT, 100 women), vitamin B1 alone (MD -2.70 points, 95% CI -3.32 to -2.08; one RCT, 120 women), zataria (OR 6.66, 95% CI 2.66 to 16.72; one RCT, 99 women), and zinc sulphate (MD -0.95 points, 95% CI -1.54 to -0.36; one RCT, 99 women).Data on chamomile and cinnamon versus placebo were unsuitable for analysis. Supplements versus NSAIDSThere was no evidence of any difference between NSAIDs and dill (MD 0.13 points, 95% CI -1.01 to 1.27; one RCT, 47 women), fennel (MD -0.70 points, 95% CI -1.81 to 0.41; one RCT, 59 women), guava (MD 1.19, 95% CI 0.42 to 1.96; one RCT, 155 women), rhubarb (MD -0.20 points, 95% CI -0.44 to 0.04; one RCT, 45 women), or valerian (MD points 0.62 , 95% CI 0.03 to 1.21; one RCT, 99 women),There was no consistent evidence of a difference between Damask rose and NSAIDs (MD -0.15 points, 95% CI -0.55 to 0.25; one RCT, 92 women).There was very limited evidence that chamomile was more effective than NSAIDs (MD -1.42 points, 95% CI -1.69 to -1.15; one RCT, 160 women). Supplements versus other supplementsThere was no evidence of a difference in effectiveness between ginger and zinc sulphate (MD 0.02 points, 95% CI -0.58 to 0.62; one RCT, 101 women). Vitamin B1 may be more effective than fish oil (MD -1.59 points, 95% CI -2.25 to -0.93; one RCT, 120 women). Effectiveness of supplements for secondary dysmenorrhoea There was no strong evidence of benefit for melatonin compared to placebo for dysmenorrhoea secondary to endometriosis (data were unsuitable for analysis). Safety of supplements Only four of the 27 included studies reported adverse effects in both treatment groups. There was no evidence of a difference between the groups but data were too scanty to reach any conclusions about safety. There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea, and evidence of safety is lacking. However for several supplements there was some low quality evidence of effectiveness and more research is justified.

Reference Values for the Pediatric Quality of Life Inventory and the Multidimensional Fatigue Scale in Adolescent Athletes by Sport and Sex.

PubMed

Snyder Valier, Alison R; Welch Bacon, Cailee E; Bay, R Curtis; Molzen, Eileen; Lam, Kenneth C; Valovich McLeod, Tamara C

2017-10-01

Effective use of patient-rated outcome measures to facilitate optimal patient care requires an understanding of the reference values of these measures within the population of interest. Little is known about reference values for commonly used patient-rated outcome measures in adolescent athletes. To determine reference values for the Pediatric Quality of Life Inventory (PedsQL) and the Multidimensional Fatigue Scale (MFS) in adolescent athletes by sport and sex. Cross-sectional study; Level of evidence, 3. A convenience sample of interscholastic adolescent athletes from 9 sports was used. Participants completed the PedsQL and MFS during one testing session at the start of their sport season. Data were stratified by sport and sex. Dependent variables included the total PedsQL score and the 5 PedsQL subscale scores: physical functioning, psychosocial functioning, emotional functioning, social functioning, and school functioning. Dependent variables for the MFS included 3 subscale scores: general functioning, sleep functioning, and cognitive functioning. Summary statistics were reported for total and subscale scores by sport and sex. Among 3574 males and 1329 female adolescent athletes, the PedsQL scores (100 possible points) generally indicated high levels of health regardless of sport played. Mean PedsQL total and subscales scores ranged from 82.6 to 95.7 for males and 83.9 to 95.2 for females. Mean MFS subscale scores (100 possible points) ranged from 74.2 to 90.9 for males and 72.8 to 87.4 for females. Healthy male and female adolescent athletes reported relatively high levels of health on the PedsQL subscales and total scores regardless of sport; no mean scores were lower than 82.6 points for males or 83.9 points for females. On the MFS, males and females tended to report low effect of general and cognitive fatigue regardless of sport; mean scores were higher than 83.5 points for males and 83.8 points for females. Clinically, athletes who score below the reference values for their sport have poorer health status than average adolescent athletes participating in that sport. Scores below reference values may warrant consideration of early intervention or treatment.

Culturally Responsive Adaptations in Evidence-Based Treatment: The Impact on Client Satisfaction

ERIC Educational Resources Information Center

Jones, Janine; Lee, Lisa; Zigarelli, Julia; Nakagawa, Yoko

2017-01-01

This study expands the literature on multicultural counseling competencies (MCCs) in school psychology by outlining the relationship between client satisfaction, treatment approaches, and critical clinician variables such as clinician MCC. With growing emphasis on the integration of cultural considerations in evidence-based treatments (EBTs), this…

Using Implementation Planning to Increase Teachers' Adherence and Quality to Behavior Support Plans

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; Collier-Meek, Melissa A.; Long, Anna C. J.; Kim, Jisun; Kratochwill, Thomas R.

2014-01-01

Evidence-based practices within a response-to-intervention framework must be implemented with adequate treatment integrity to promote student outcomes. However, research findings indicate educators struggle to implement interventions and logistical considerations may limit the utility of performance feedback, an evidence-based treatment integrity…

Evidence-Based Practices in Special Education: Current Assumptions and Future Considerations

ERIC Educational Resources Information Center

Russo-Campisi, Jacqueline

2017-01-01

Background: The research on evidence-based practices (EBP) in special education has shifted over the last decade from identifying efficacious interventions to exploring issues that impede implementation in the classroom. Common barriers to implementation include absence of training and resources, limited collaboration between researchers and…

Little Evidence and Big Consequences: Understanding Special Education Voucher Programs

ERIC Educational Resources Information Center

Braun, Matthew

2017-01-01

This report examines the characteristics of state special education voucher programs along with the evidence base on their impact, effectiveness, and quality. The report, which finds that the program characteristics differ considerably across states and that the research is small, dated, and often funded by voucher proponents, identifies major…

Design Considerations for Siting Grade Control Structures

DTIC Science & Technology

2001-12-01

require consideration before siting grade control structures. In the widest sense, the term grade control can be applied to any alteration in the...control structures. There are two basic types of grade control structures. One type can be referred to as a bed control structure as it is designed to...provide a hard point in the streambed that is capable of resisting the erosive forces of the degradational zone. The second type can be referred to

Workplace interventions for reducing sitting at work.

PubMed

Shrestha, Nipun; Kukkonen-Harjula, Katriina T; Verbeek, Jos H; Ijaz, Sharea; Hermans, Veerle; Bhaumik, Soumyadeep

2016-03-17

Office work has changed considerably over the previous couple of decades and has become sedentary in nature. Physical inactivity at workplaces and particularly increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. To evaluate the effects of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, OSH UPDATE, PsycINFO, Clinical trials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to 2 June, 2015. We also screened reference lists of articles and contacted authors to find more studies to include. We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cRCTs), and quasi-randomised controlled trials of interventions to reduce sitting at work. For changes of workplace arrangements, we also included controlled before-and-after studies (CBAs) with a concurrent control group. The primary outcome was time spent sitting at work per day, either self-reported or objectively measured by means of an accelerometer-inclinometer. We considered energy expenditure, duration and number of sitting episodes lasting 30 minutes or more, work productivity and adverse events as secondary outcomes. Two review authors independently screened titles, abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. We included 20 studies, two cross-over RCTs, 11 RCTs, three cRCTs and four CBAs, with a total of 2180 participants from high income nations. The studies evaluated physical workplace changes (nine studies), policy changes (two studies), information and counselling (seven studies) and interventions from multiple categories (two studies). One study had both physical workplace changes and information and counselling components. We did not find any studies that had investigated the effect of periodic breaks or standing or walking meetings. Physical workplace changesA sit-stand desk alone compared to no intervention reduced sitting time at work per workday with between thirty minutes to two hours at short term (up to three months) follow-up (six studies, 218 participants, very low quality evidence). In two studies, sit-stand desks with additional counselling reduced sitting time at work in the same range at short-term follow-up (61 participants, very low quality evidence). One study found a reduction at six months' follow-up of -56 minutes (95% CI -101 to -12, very low quality evidence) compared to no intervention. Also total sitting time at work and outside work decreased with sit-stand desks compared to no intervention (MD -78 minutes, 95% CI -125 to -31, one study) as did the duration of sitting episodes lasting 30 minutes or more (MD -52 minutes, 95% CI -79 to -26, two studies). This is considerably less than the two to four hours recommended by experts. Sit-stand desks did not have a considerable effect on work performance, musculoskeletal symptoms or sick leave. It remains unclear if standing can repair the harms of sitting because there is hardly any extra energy expenditure.The effects of active workstations were inconsistent. Treadmill desks combined with counselling reduced sitting time at work (MD -29 minutes, 95% CI -55 to -2, one study) compared to no intervention at 12 weeks' follow-up. Pedalling workstations combined with information did not reduce inactive sitting at work considerably (MD -12 minutes, 95% CI -24 to 1, one study) compared to information alone at 16 weeks' follow-up. The quality of evidence was low for active workstations. Policy changesTwo studies with 443 participants provided low quality evidence that walking strategies did not have a considerable effect on workplace sitting time at 10 weeks' (MD -16 minutes, 95% CI -54 to 23) or 21 weeks' (MD -17 minutes, 95% CI -58 to 25) follow-up respectively. Information and counsellingCounselling reduced sitting time at work (MD -28 minutes, 95% CI -52 to -5, two studies, low quality evidence) at medium term (three months to 12 months) follow-up. Mindfulness training did not considerably reduce workplace sitting time (MD -2 minutes, 95% CI -22 to 18) at six months' follow-up and at 12 months' follow-up (MD -16 minutes, 95% CI -45 to 12, one study, low quality evidence). There was no considerable increase in work engagement with counselling.There was an inconsistent effect of computer prompting on sitting time at work. One study found no considerable effect on sitting at work (MD -17 minutes, 95% CI -48 to 14, low quality evidence) at 10 days' follow-up, while another study reported a significant reduction in sitting at work (MD -55 minutes, 95% CI -96 to -14, low quality evidence) at 13 weeks' follow-up. Computer prompts to stand reduced sitting at work by 14 minutes more (95% CI 10 to 19, one study) compared to computer prompts to step at six days' follow-up. Computer prompts did not change the number of sitting episodes that last 30 minutes or longer. Interventions from multiple categories Interventions combining multiple categories had an inconsistent effect on sitting time at work, with a reduction in sitting time at 12 weeks' (25 participants, very low quality evidence) and six months' (294 participants, low quality evidence) follow-up in two studies but no considerable effect at 12 months' follow-up in one study (MD -47.98, 95% CI -103 to 7, 294 participants, low quality evidence). At present there is very low to low quality evidence that sit-stand desks may decrease workplace sitting between thirty minutes to two hours per day without having adverse effects at the short or medium term. There is no evidence on the effects in the long term. There were no considerable or inconsistent effects of other interventions such as changing work organisation or information and counselling. There is a need for cluster-randomised trials with a sufficient sample size and long term follow-up to determine the effectiveness of different types of interventions to reduce objectively measured sitting time at work.

Experimental Design Considerations for Establishing an Off-Road, Habitat-Specific Bird Monitoring Program Using Point Counts

Treesearch

JoAnn M. Hanowski; Gerald J. Niemi

1995-01-01

We established bird monitoring programs in two regions of Minnesota: the Chippewa National Forest and the Superior National Forest. The experimental design defined forest cover types as strata in which samples of forest stands were randomly selected. Subsamples (3 point counts) were placed in each stand to maximize field effort and to assess within-stand and between-...

Design considerations for examining trends in avian abundance using point counts: examples from oak woodlands

Treesearch

Kathryn L. Purcell; Sylvia R. Mori; Mary K. Chase

2005-01-01

We used data from two oak-woodland sites in California to develop guidelines for the design of bird monitoring programs using point counts. We used power analysis to determine sample size adequacy when varying the number of visits, count stations, and years for examining trends in abundance. We assumed an overdispersed Poisson distribution for count data, with...

Evidence to support controversy in microsurgery.

PubMed

Fan, Kenneth L; Patel, Ketan M; Mardini, Samir; Attinger, Christopher; Levin, L Scott; Evans, Karen K

2015-03-01

Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

How might we increase physical activity through dog walking?: A comprehensive review of dog walking correlates.

PubMed

Westgarth, Carri; Christley, Robert M; Christian, Hayley E

2014-08-20

Physical inactivity and sedentary behaviour are major threats to population health. A considerable proportion of people own dogs, and there is good evidence that dog ownership is associated with higher levels of physical activity. However not all owners walk their dogs regularly. This paper comprehensively reviews the evidence for correlates of dog walking so that effective interventions may be designed to increase the physical activity of dog owners. Published findings from 1990-2012 in both the human and veterinary literature were collated and reviewed for evidence of factors associated with objective and self-reported measures of dog walking behaviour, or reported perceptions about dog walking. Study designs included cross-sectional observational, trials and qualitative interviews. There is good evidence that the strength of the dog-owner relationship, through a sense of obligation to walk the dog, and the perceived support and motivation a dog provides for walking, is strongly associated with increased walking. The perceived exercise requirements of the dog may also be a modifiable point for intervention. In addition, access to suitable walking areas with dog supportive features that fulfil dog needs such as off-leash exercise, and that also encourage human social interaction, may be incentivising. Current evidence suggests that dog walking may be most effectively encouraged through targeting the dog-owner relationship and by providing dog-supportive physical environments. More research is required to investigate the influence of individual owner and dog factors on 'intention' to walk the dog as well as the influence of human social interaction whilst walking a dog. The effects of policy and cultural practices relating to dog ownership and walking should also be investigated. Future studies must be of a higher quality methodological design, including accounting for the effects of confounding between variables, and longitudinal designs and testing of interventions in a controlled design in order to infer causality.

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.

PubMed

Sanello, Ashley; Gausche-Hill, Marianne; Mulkerin, William; Sporer, Karl A; Brown, John F; Koenig, Kristi L; Rudnick, Eric M; Salvucci, Angelo A; Gilbert, Gregory H

2018-05-01

In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

Evidence for balancing selection at the DAB locus in the axolotl, Ambystoma mexicanum.

PubMed

Richman, A D; Herrera, G; Reynoso, V H; Méndez, G; Zambrano, L

2007-12-01

The axolotl (Ambystoma mexicanum) has been characterized as immunodeficient, and the absence of major histocompatibility complex (MHC) class II polymorphism has been cited as a possible explanation. Here we present evidence for considerable allelic polymorphism at the MHC class II DAB locus for a sample of wild-caught axolotls. Evidence that these sequences are the product of balancing selection for disease resistance is discussed.

Introducing a Chair-Side Novel Approach to Reach Evidence-based Periodontal Information in the Daily Periodontal Practice

PubMed Central

Dannan, Aous

2009-01-01

Background Evidence-based healthcare is not an easier approach to patient management, but should provide both clinicians and patients with greater confidence and trust in their mutual relationship. The intellectual embrace of evidence-based methods, coupled with clinical expertise and consideration of the patients individual uniqueness and requirements, is needed for all periodontal therapists if optimum care is the goal. One important element of evidence-based decision making in periodontology is the systematic review. Systematic reviews usually provide the periodontist with the highest level of evidence which should be taken into consideration when constructing any treatment plan in the dental clinic. However, reaching systematic reviews might be a time-consuming procedure that needs further personal skills. Methods In this paper, a chair-side novel approach to facilitate the incorporation of systematic reviews into daily periodontal practice is presented. It is based on three simple tools, namely, a list of suitable periodontics-related key words, a data bank of all up-to-date published systematic reviews in periodontology, and hand-made paper sheets to match the key words with their related systematic review statements. Results and Conclusions A primary validation of this method indicated the simplicity in learning and application. Keywords Chair-side; Evidence-based medicine; Periodontology; Systematic review PMID:22461868

14 CFR 34.7 - Exemptions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... flights essential to demonstrate the integrity of an aircraft prior to a flight to a point outside the... upon consideration of— (1) Adverse economic impact on the manufacturer; (2) Adverse economic impact on...

12 CFR 1815.114 - Fund decisionmaking procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of no significant impact, or notice of intent, in addition to being prepared at the earliest point in... decisionmaking process to ensure adequate consideration of environmental factors; (b) The Decisionmaker shall...

Mars surface penetrator: System description

NASA Technical Reports Server (NTRS)

Manning, L. A. (Editor)

1977-01-01

A point design of a penetrator system for a Mars mission is described. A strawman payload which is to conduct measurements of geophysical and meteorological parameters is included in the design. The subsystems used in the point design are delineated in terms of power, mass, volume, data, and functional modes. The prospects for survival of the rigors of emplacement are described. Data handling and communications plans are presented to allow consideration of the requirements placed by the penetrator on the orbiter and ground operations. The point design is technically feasible and the payload selection scientifically desirable.

Transport-induced shifts in condensate dew-point and composition in multicomponent systems with chemical reaction

NASA Technical Reports Server (NTRS)

Rosner, D. E.; Nagarajan, R.

1985-01-01

Partial heterogeneous condensation phenomena in multicomponent reacting systems are analyzed taking into consideration the chemical element transport phenomena. It is demonstrated that the dew-point surface temperature in chemically reactive systems is not a purely thermodynamic quantity, but is influenced by the multicomponent diffusion and Soret-mass diffusion phenomena. Several distinct dew-points are shown to exist in such systems and, as a result of transport constraints, the 'sharp' locus between two chemically distinct condensates is systematically moved to a difference mainstream composition.

Workplace interventions to prevent work disability in workers on sick leave.

PubMed

van Vilsteren, Myrthe; van Oostrom, Sandra H; de Vet, Henrica C W; Franche, Renée-Louise; Boot, Cécile R L; Anema, Johannes R

2015-10-05

Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.

Analogy in causal inference: rethinking Austin Bradford Hill's neglected consideration.

PubMed

Weed, Douglas L

2018-05-01

The purpose of this article was to rethink and resurrect Austin Bradford Hill's "criterion" of analogy as an important consideration in causal inference. In epidemiology today, analogy is either completely ignored (e.g., in many textbooks), or equated with biologic plausibility or coherence, or aligned with the scientist's imagination. None of these examples, however, captures Hill's description of analogy. His words suggest that there may be something gained by contrasting two bodies of evidence, one from an established causal relationship, the other not. Coupled with developments in the methods of systematic assessments of evidence-including but not limited to meta-analysis-analogy can be restructured as a key component in causal inference. This new approach will require that a collection-a library-of known cases of causal inference (i.e., bodies of evidence involving established causal relationships) be developed. This library would likely include causal assessments by organizations such as the International Agency for Research on Cancer, the National Toxicology Program, and the United States Environmental Protection Agency. In addition, a process for describing key features of a causal relationship would need to be developed along with what will be considered paradigm cases of causation. Finally, it will be important to develop ways to objectively compare a "new" body of evidence with the relevant paradigm case of causation. Analogy, along with all other existing methods and causal considerations, may improve our ability to identify causal relationships. Copyright © 2018 Elsevier Inc. All rights reserved.

Randomised, double blind, placebo controlled trial of intravenous antioxidant (n‐acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis

PubMed Central

Siriwardena, Ajith K; Mason, James M; Balachandra, Srinivasan; Bagul, Anil; Galloway, Simon; Formela, Laura; Hardman, Jonathan G; Jamdar, Saurabh

2007-01-01

Background Based on equivocal clinical data, intravenous antioxidant therapy has been used for the treatment of severe acute pancreatitis. To date there is no randomised comparison of this therapy in severe acute pancreatitis. Methods We conducted a randomised, double blind, placebo controlled trial of intravenous antioxidant (n‐acetylcysteine, selenium, vitamin C) therapy in patients with predicted severe acute pancreatitis. Forty‐three patients were enrolled from three hospitals in the Manchester (UK) area over the period June 2001 to November 2004. Randomisation stratified for APACHE‐II score and hospital site, and delivered groups that were similar at baseline. Results Relative serum levels of antioxidants rose while markers of oxidative stress fell in the active treatment group during the course of the trial. However, at 7 days, there was no statistically significant difference in the primary end point, organ dysfunction (antioxidant vs placebo: 32% vs 17%, p = 0.33) or any secondary end point of organ dysfunction or patient outcome. Conclusions This study provides no evidence to justify continued use of n‐acetylcysteine, selenium, vitamin C based antioxidant therapy in severe acute pancreatitis. In the context of any future trial design, careful consideration must be given to the risks raised by the greater trend towards adverse outcome in patients in the treatment arm of this study. PMID:17356040

Technical considerations and precautions in in situ bronchoalveolar lavage and alveolar infiltrating cells isolation in rats.

PubMed

Qamar, Wajhul

2015-01-01

Bronchoalveolar lavage fluid (BALF) is an important tool in experimental toxicology and pharmacology. A number of researchers have utilized BAL in studies involving rodents. However, the detailed procedure of performing BAL in rodents has rarely been reported. In the present article, in situ BAL in rats has been described with technical points that ensure the quality and validity of BALF samples. BAL was performed in rats of Wistar strain. Flow cytometry and microscopy were utilized to analyze the BAL cells. The collected volume of BALF was 84.32 ± 2.7% of instilled volume. Alveolar macrophages were found to be prevalent in normal lungs when analyzed under microscope and by flow cytometry. The main problem that one may face is the accidental contamination of BALF samples with blood of the animal itself. Presence of blood in BALF certainly adds a significant number of cells and other biochemical variables. No blood contamination was detected in BALF. Here, a simple procedure for BAL and collection of alveolar cells (macrophages in the present study) is explained with an emphasis on technical steps and precautions, which ensures the quality of the BALF samples. Data exhibit that there is no blood contamination in the BALF and provide evidence that the technical points considered in the procedure here are successful in maintaining the quality and validity of BALF samples.

Programming maternal and child overweight and obesity in the context of undernutrition: current evidence and key considerations for low- and middle-income countries.

PubMed

Jaacks, Lindsay M; Kavle, Justine; Perry, Abigail; Nyaku, Albertha

2017-05-01

The goals of the present targeted review on maternal and child overweight and obesity were to: (i) understand the current situation in low- and middle-income countries (LMIC) with regard to recent trends and context-specific risk factors; and (ii) building off this, identify entry points for leveraging existing undernutrition programmes to address overweight and obesity in LMIC. Trends reveal that overweight and obesity are a growing problem among women and children in LMIC; as in Ghana, Kenya, Niger, Sierra Leone, Tanzania and Zimbabwe, where the prevalence among urban women is approaching 50 %. Four promising entry points were identified: (i) the integration of overweight and obesity into national nutrition plans; (ii) food systems (integration of food and beverage marketing regulations into existing polices on the marketing of breast-milk substitutes and adoption of policies to promote healthy diets); (iii) education systems (integration of nutrition into school curricula with provision of high-quality foods through school feeding programmes); and (iv) health systems (counselling and social and behaviour change communication to improve maternal diet, appropriate gestational weight gain, and optimal infant and young child feeding practices). We conclude by presenting a step-by-step guide for programme officers and policy makers in LMIC with actionable objectives to address overweight and obesity.

Prevalence of Posttraumatic Stress Disorder in Prisoners.

PubMed

Baranyi, Gergõ; Cassidy, Megan; Fazel, Seena; Priebe, Stefan; Mundt, Adrian P

2018-06-01

People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n < 100), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.

Metabolic syndrome, endocrine disruptors and prostate cancer associations: biochemical and pathophysiological evidences

PubMed Central

Quagliariello, Vincenzo; Rossetti, Sabrina; Cavaliere, Carla; Di Palo, Rossella; Lamantia, Elvira; Castaldo, Luigi; Nocerino, Flavia; Ametrano, Gianluca; Cappuccio, Francesca; Malzone, Gabriella; Montanari, Micaela; Vanacore, Daniela; Romano, Francesco Jacopo; Piscitelli, Raffaele; Iovane, Gelsomina; Pepe, Maria Filomena; Berretta, Massimiliano; D'Aniello, Carmine; Perdonà, Sisto; Muto, Paolo; Botti, Gerardo; Ciliberto, Gennaro; Veneziani, Bianca Maria; De Falco, Francesco; Maiolino, Piera; Caraglia, Michele; Montella, Maurizio; Iaffaioli, Rosario Vincenzo; Facchini, Gaetano

2017-01-01

This review summarizes the main pathophysiological basis of the relationship between metabolic syndrome, endocrine disruptor exposure and prostate cancer that is the most common cancer among men in industrialized countries. Metabolic syndrome is a cluster of metabolic and hormonal factors having a central role in the initiation and recurrence of many western chronic diseases including hormonal-related cancers and it is considered as the worlds leading health problem in the coming years. Many biological factors correlate metabolic syndrome to prostate cancer and this review is aimed to focus, principally, on growth factors, cytokines, adipokines, central obesity, endocrine abnormalities and exposure to specific endocrine disruptors, a cluster of chemicals, to which we are daily exposed, with a hormone-like structure influencing oncogenes, tumor suppressors and proteins with a key role in metabolism, cell survival and chemo-resistance of prostate cancer cells. Finally, this review will analyze, from a molecular point of view, how specific foods could reduce the relative risk of incidence and recurrence of prostate cancer or inhibit the biological effects of endocrine disruptors on prostate cancer cells. On the basis of these considerations, prostate cancer remains a great health problem in terms of incidence and prevalence and interventional studies based on the treatment of metabolic syndrome in cancer patients, minimizing exposure to endocrine disruptors, could be a key point in the overall management of this disease. PMID:28389628

Metabolic syndrome, endocrine disruptors and prostate cancer associations: biochemical and pathophysiological evidences.

PubMed

Quagliariello, Vincenzo; Rossetti, Sabrina; Cavaliere, Carla; Di Palo, Rossella; Lamantia, Elvira; Castaldo, Luigi; Nocerino, Flavia; Ametrano, Gianluca; Cappuccio, Francesca; Malzone, Gabriella; Montanari, Micaela; Vanacore, Daniela; Romano, Francesco Jacopo; Piscitelli, Raffaele; Iovane, Gelsomina; Pepe, Maria Filomena; Berretta, Massimiliano; D'Aniello, Carmine; Perdonà, Sisto; Muto, Paolo; Botti, Gerardo; Ciliberto, Gennaro; Veneziani, Bianca Maria; De Falco, Francesco; Maiolino, Piera; Caraglia, Michele; Montella, Maurizio; Iaffaioli, Rosario Vincenzo; Facchini, Gaetano

2017-05-02

This review summarizes the main pathophysiological basis of the relationship between metabolic syndrome, endocrine disruptor exposure and prostate cancer that is the most common cancer among men in industrialized countries. Metabolic syndrome is a cluster of metabolic and hormonal factors having a central role in the initiation and recurrence of many western chronic diseases including hormonal-related cancers and it is considered as the world's leading health problem in the coming years. Many biological factors correlate metabolic syndrome to prostate cancer and this review is aimed to focus, principally, on growth factors, cytokines, adipokines, central obesity, endocrine abnormalities and exposure to specific endocrine disruptors, a cluster of chemicals, to which we are daily exposed, with a hormone-like structure influencing oncogenes, tumor suppressors and proteins with a key role in metabolism, cell survival and chemo-resistance of prostate cancer cells. Finally, this review will analyze, from a molecular point of view, how specific foods could reduce the relative risk of incidence and recurrence of prostate cancer or inhibit the biological effects of endocrine disruptors on prostate cancer cells. On the basis of these considerations, prostate cancer remains a great health problem in terms of incidence and prevalence and interventional studies based on the treatment of metabolic syndrome in cancer patients, minimizing exposure to endocrine disruptors, could be a key point in the overall management of this disease.

The Brazilian version of the Constant-Murley Score (CMS-BR): convergent and construct validity, internal consistency, and unidimensionality.

PubMed

Barreto, Rodrigo Py Gonçalves; Barbosa, Marcus Levi Lopes; Balbinotti, Marcos Alencar Abaide; Mothes, Fernando Carlos; da Rosa, Luís Henrique Telles; Silva, Marcelo Faria

2016-01-01

To translate and culturally adapt the CMS and assess the validity of the Brazilian version (CMS-BR). The translation was carried out according to the back-translation method by four independent translators. The produced versions were synthesized through extensive analysis and by consensus of an expert committee, reaching a final version used for the cultural adaptation. A field test was conducted with 30 subjects in order to obtain semantic considerations. For the psychometric analyzes, the sample was increased to 110 participants who answered two instruments: CMS-BR and the Disabilities of the Arm, shoulder and Hand (DASH). The CMS-BR and DASH score range from 0 to 100 points. For the first, higher points reflect better function and for the latter, the inverse is true. The validity was verified by Pearson's correlation test, the unidimensionality by factorial analysis, and the internal consistency by Cronbach's alpha. The explained variance was 60.28% with factor loadings ranging from 0.60 to 0.91. The CMS-BR exhibited strong negative correlation with the DASH score (-0.82, p  < 0.05), Cronbach's alpha 0.85, and its total score was strongly correlated with the patient's range of motion (0.93, p  < 0.001). The CMS was satisfactorily adapted for Brazilian Portuguese and demonstrated evidence of validity that allows its use in this population.

Language-related differential item functioning between English and German PROMIS Depression items is negligible.

PubMed

Fischer, H Felix; Wahl, Inka; Nolte, Sandra; Liegl, Gregor; Brähler, Elmar; Löwe, Bernd; Rose, Matthias

2017-12-01

To investigate differential item functioning (DIF) of PROMIS Depression items between US and German samples we compared data from the US PROMIS calibration sample (n = 780), a German general population survey (n = 2,500) and a German clinical sample (n = 621). DIF was assessed in an ordinal logistic regression framework, with 0.02 as criterion for R 2 -change and 0.096 for Raju's non-compensatory DIF. Item parameters were initially fixed to the PROMIS Depression metric; we used plausible values to account for uncertainty in depression estimates. Only four items showed DIF. Accounting for DIF led to negligible effects for the full item bank as well as a post hoc simulated computer-adaptive test (< 0.1 point on the PROMIS metric [mean = 50, standard deviation =10]), while the effect on the short forms was small (< 1 point). The mean depression severity (43.6) in the German general population sample was considerably lower compared to the US reference value of 50. Overall, we found little evidence for language DIF between US and German samples, which could be addressed by either replacing the DIF items by items not showing DIF or by scoring the short form in German samples with the corrected item parameters reported. Copyright © 2016 John Wiley & Sons, Ltd.

Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care

PubMed Central

Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

2015-01-01

As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. With hospital-level panel data from Medicare cost reports, we used difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007–13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7 to 9 percentage points, relative to a baseline rate of 11 percent, and 7 to 8 percentage point increase in Medicaid revenue as a share of total revenue, relative to baseline share of 9.5 percent.. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals’ uncompensated care burden. PMID:26153312

Ionosphere of venus: first observations of day-night variations of the ion composition.

PubMed

Taylor, H A; Brinton, H C; Bauer, S J; Hartle, R E; Cloutier, P A; Daniell, R E; Donahue, T M

1979-07-06

The Bennett radio-frequency ion mass spectrometer on the Pioneer Venus orbiter is returning the first direct composition evidence of the processes responsible for the formation and maintenance of the nightside ionosphere. Early results from predusk through the nightside in the solar zenith angle range 63 degrees (dusk) to 120 degrees (dawn) reveal that, as on the dayside, the lower nightside ionosphere consists of F(1)and F(2) layers dominated by O(2)(+) and O(+), respectively. Also like the dayside, the nightside composition includes distributions of NO(+), C(+), N(+), H(+), He(+), CO(2)(+), and 28(+) (a combination of CO(+) and N(2)(+)). The surprising abundance of the nightside ionosphere appears to be maintained by the transport of O(+) from the dayside, leading also to the formation of O(2)(+) through charge exchange with CO(2). Above the exobase, the upper nightside ionosphere exhibits dramatic variability in apparent response to variations in the solar wind and interplanetary magnetic field, with the ionopause extending to several thousand kilometers on one orbit, followed by the complete rertnoval of thermal ions to altitudes below 200 kilometers on the succeeding orbit, 24 hours later. In the upper ionosphere, considerable structure is evident in many of the nightside ion profiles. Also evident are horizontal ion drifts with velocities up to the order of 1 kilometer per second. Whereas the duskside ionopause is dominated by O(+) H(+) dominates the topside on the dawnside of the antisolar point, indicating two separate regions for ion depletion in the magnetic tail regions.

Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India

PubMed Central

Sharma, Surendra K.; Ryan, H.; Khaparde, Sunil; Sachdeva, K. S.; Singh, Achintya D.; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

2017-01-01

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research. PMID:28862176

Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation

PubMed Central

2011-01-01

Active myofascial trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions. Myofascial trigger points are also the targets for acupuncture and/or dry needling therapies. Recent evidence in the understanding of the pathophysiology of myofascial trigger points supports The Integrated Hypothesis for the trigger point formation; however unanswered questions remain. Current evidence shows that spontaneous electrical activity at myofascial trigger point originates from the extrafusal motor endplate. The spontaneous electrical activity represents focal muscle fiber contraction and/or muscle cramp potentials depending on trigger point sensitivity. Local pain and tenderness at myofascial trigger points are largely due to nociceptor sensitization with a lesser contribution from non-nociceptor sensitization. Nociceptor and non-nociceptor sensitization at myofascial trigger points may be part of the process of muscle ischemia associated with sustained focal muscle contraction and/or muscle cramps. Referred pain is dependent on the sensitivity of myofascial trigger points. Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy. PMID:21439050

Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder.

PubMed

Gerger, H; Munder, T; Gemperli, A; Nüesch, E; Trelle, S; Jüni, P; Barth, J

2014-11-01

To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD). We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics. The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between -1.10 and -1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs -0.58 and -0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ²= 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias. Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.

Cellular changes in the enteric nervous system during ageing.

PubMed

Saffrey, M Jill

2013-10-01

The intrinsic neurons of the gut, enteric neurons, have an essential role in gastrointestinal functions. The enteric nervous system is plastic and continues to undergo changes throughout life, as the gut grows and responds to dietary and other environmental changes. Detailed analysis of changes in the ENS during ageing suggests that enteric neurons are more vulnerable to age-related degeneration and cell death than neurons in other parts of the nervous system, although there is considerable variation in the extent and time course of age-related enteric neuronal loss reported in different studies. Specific neuronal subpopulations, particularly cholinergic myenteric neurons, may be more vulnerable than others to age-associated loss or damage. Enteric degeneration and other age-related neuronal changes may contribute to gastrointestinal dysfunction that is common in the elderly population. Evidence suggests that caloric restriction protects against age-associated loss of enteric neurons, but recent advances in the understanding of the effects of the microbiota and the complex interactions between enteric ganglion cells, mucosal immune system and intestinal epithelium indicate that other factors may well influence ageing of enteric neurons. Much remains to be understood about the mechanisms of neuronal loss and damage in the gut, although there is evidence that reactive oxygen species, neurotrophic factor dysregulation and/or activation of a senescence associated phenotype may be involved. To date, there is no evidence for ongoing neurogenesis that might replace dying neurons in the ageing gut, although small local sites of neurogenesis would be difficult to detect. Finally, despite the considerable evidence for enteric neurodegeneration during ageing, and evidence for some physiological changes in animal models, the ageing gut appears to maintain its function remarkably well in animals that exhibit major neuronal loss, indicating that the ENS has considerable functional reserve. © 2013 Elsevier Inc. All rights reserved.

Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

PubMed Central

Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

2014-01-01

Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458

Incorporating Mobile Phone Technologies to Expand Evidence-Based Care.

PubMed

Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

2015-08-01

Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

Frequency choice of eRHIC SRF linac

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, W.; Ben-Zvi, I.; Roser, T.

2016-01-05

eRHIC is a FFAG lattice-based multipass ERL. The eRHIC SRF linac has been decided to change from 422 MHz 5-cell cavity to 647 MHz 5-cell cavity. There are several considerations affecting the frequency choice for a high-current multipass-ERL: the beam structure, bunch length, energy spread, beam-break-up (BBU) threshold, SRF loss considerations. Beyond the physics considerations, cost and complexity or risk is an important consideration for the frequency choice, especially when we are designing a machine to be built in a few years. Although there are some benefits of using a 422 MHz cavity for eRHIC ERL, however, there are somemore » very critical drawbacks, including lack of facilities to fabricate a 422 MHz 5-cell cavity, very few facilities to process such a cavity and no existing facility to test the cavity anywhere. As the cavity size is big and its weight is large, it is difficult to handle it during fabrication, processing and testing, and no one has experience in this area. As the cavity size is large, the cryomodule becomes big as well. All of these considerations drive the risk of building eRHIC ERL with 422 MHz cavities to a very high level. Therefore, a decision was made to change the frequency of main linac to be 647 MHz 5-cell cavities. This note will compare these two linacs: 422MHz 5-cell cavity linac and 647Mz 5-cell cavity SRF linac, from both practical point of view and physics point of view.« less

Community-based restaurant interventions to promote healthy eating: a systematic review.

PubMed

Valdivia Espino, Jennifer N; Guerrero, Natalie; Rhoads, Natalie; Simon, Norma-Jean; Escaron, Anne L; Meinen, Amy; Nieto, F Javier; Martinez-Donate, Ana P

2015-05-21

Eating in restaurants is associated with high caloric intake. This review summarizes and evaluates the evidence supporting community-based restaurant interventions. We searched all years of PubMed and Web of Knowledge through January 2014 for original articles describing or evaluating community-based restaurant interventions to promote healthy eating. We extracted summary information and classified the interventions into 9 categories according to the strategies implemented. A scoring system was adapted to evaluate the evidence, assigning 0 to 3 points to each intervention for study design, public awareness, and effectiveness. The average values were summed and then multiplied by 1 to 3 points, according to the volume of research available for each category. These summary scores were used to determine the level of evidence (insufficient, sufficient, or strong) supporting the effectiveness of each category. This review included 27 interventions described in 25 studies published since 1979. Most interventions took place in exclusively urban areas of the United States, either in the West or the South. The most common intervention categories were the use of point-of-purchase information with promotion and communication (n = 6), and point-of-purchase information with increased availability of healthy choices (n = 6). Only the latter category had sufficient evidence. The remaining 8 categories had insufficient evidence because of interventions showing no, minimal, or mixed findings; limited reporting of awareness and effectiveness; low volume of research; or weak study designs. No intervention reported an average negative impact on outcomes. Evidence about effective community-based strategies to promote healthy eating in restaurants is limited, especially for interventions in rural areas. To expand the evidence base, more studies should be conducted using robust study designs, standardized evaluation methods, and measures of sales, behavior, and health outcomes.

Community-Based Restaurant Interventions to Promote Healthy Eating: A Systematic Review

PubMed Central

Valdivia Espino, Jennifer N.; Guerrero, Natalie; Rhoads, Natalie; Simon, Norma-Jean; Escaron, Anne L.; Meinen, Amy; Nieto, F. Javier

2015-01-01

Introduction Eating in restaurants is associated with high caloric intake. This review summarizes and evaluates the evidence supporting community-based restaurant interventions. Methods We searched all years of PubMed and Web of Knowledge through January 2014 for original articles describing or evaluating community-based restaurant interventions to promote healthy eating. We extracted summary information and classified the interventions into 9 categories according to the strategies implemented. A scoring system was adapted to evaluate the evidence, assigning 0 to 3 points to each intervention for study design, public awareness, and effectiveness. The average values were summed and then multiplied by 1 to 3 points, according to the volume of research available for each category. These summary scores were used to determine the level of evidence (insufficient, sufficient, or strong) supporting the effectiveness of each category. Results This review included 27 interventions described in 25 studies published since 1979. Most interventions took place in exclusively urban areas of the United States, either in the West or the South. The most common intervention categories were the use of point-of-purchase information with promotion and communication (n = 6), and point-of-purchase information with increased availability of healthy choices (n = 6). Only the latter category had sufficient evidence. The remaining 8 categories had insufficient evidence because of interventions showing no, minimal, or mixed findings; limited reporting of awareness and effectiveness; low volume of research; or weak study designs. No intervention reported an average negative impact on outcomes. Conclusion Evidence about effective community-based strategies to promote healthy eating in restaurants is limited, especially for interventions in rural areas. To expand the evidence base, more studies should be conducted using robust study designs, standardized evaluation methods, and measures of sales, behavior, and health outcomes. PMID:25996986

Determination by ray-tracing of the regions where mid-latitude whistlers exit from the lower ionosphere

NASA Astrophysics Data System (ADS)

Strangeways, H. J.

1981-03-01

The size and position of the regions in the bottomside ionosphere through which downcoming whistlers emerge are estimated using ray-tracing calculations in both summer day and winter night models of the magnetospheric plasma. Consideration is given to the trapping of upgoing whistler-mode waves through both the base and the side of ducts. It is found that for downcoming rays which were trapped in the duct in the summer day model, the limited range of wave-normal angles which can be transmitted from the lower ionosphere to free space below causes the size of the exit point to be considerably smaller than the region of incidence. The exit point is found to be approximately 100 km in size, which agrees with ground-based observations of fairly narrow trace whistlers. For rays trapped in the duct in the winter night model, it is found that the size of the exit point is more nearly the same as the range of final latitudes of the downcoming rays in the lower ionosphere.

More than Limited Learning: The Case for Focusing on the Disciplines

ERIC Educational Resources Information Center

Heiland, Donna; Rosenthal, Laura J.

2013-01-01

In their 2011 study "Academically Adrift," Richard Arum and Josipa Roksa present considerable evidence that undergraduates in US colleges and universities make surprisingly little progress in their first two years of college. While acknowledging the force of this argument, the authors ask whether Arum and Roksa's evidence--about students'…

Rapid Automatized Naming and Reading Performance: A Meta-Analysis

ERIC Educational Resources Information Center

Araújo, Susana; Reis, Alexandra; Petersson, Karl Magnus; Faísca, Luís

2015-01-01

Evidence that rapid naming skill is associated with reading ability has become increasingly prevalent in recent years. However, there is considerable variation in the literature concerning the magnitude of this relationship. The objective of the present study was to provide a comprehensive analysis of the evidence on the relationship between rapid…

A Preliminary Investigation of the Empirical Validity of Study Quality Appraisal

ERIC Educational Resources Information Center

Cook, Bryan G.; Dupuis, Danielle N.; Jitendra, Asha K.

2017-01-01

When classifying the evidence base of practices, special education scholars typically appraise study quality to identify and exclude from consideration in their reviews unacceptable-quality studies that are likely biased and might bias review findings if included. However, study quality appraisals used in the process of identifying evidence-based…

From Instructional Leadership to Leadership Capabilities: Empirical Findings and Methodological Challenges

ERIC Educational Resources Information Center

Robinson, Viviane M. J.

2010-01-01

While there is considerable evidence about the impact of instructional leadership on student outcomes, there is far less known about the leadership capabilities that are required to confidently engage in the practices involved. This article uses the limited available evidence, combined with relevant theoretical analyses, to propose a tentative…

20 CFR 332.7 - Consideration of evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... in rotating extra board, pool, or chain gang service shall, in the absence of evidence to the... work during the period covered by his claim. When it appears clear that an employee in rotating extra board, pool, or chain gang service who fails to report the number of miles or hours' credit earned on...

20 CFR 332.7 - Consideration of evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... in rotating extra board, pool, or chain gang service shall, in the absence of evidence to the... work during the period covered by his claim. When it appears clear that an employee in rotating extra board, pool, or chain gang service who fails to report the number of miles or hours' credit earned on...

Core Intervention Components: Identifying and Operationalizing What Makes Programs Work. ASPE Research Brief

ERIC Educational Resources Information Center

Blase, Karen; Fixsen, Dean

2013-01-01

This brief is part of a series that explores key implementation considerations. It focuses on the importance of identifying, operationalizing, and implementing the "core components" of evidence-based and evidence-informed interventions that likely are critical to producing positive outcomes. The brief offers a definition of "core components",…

Implicit Word Learning Benefits from Semantic Richness: Electrophysiological and Behavioral Evidence

ERIC Educational Resources Information Center

Rabovsky, Milena; Sommer, Werner; Abdel Rahman, Rasha

2012-01-01

Words differ considerably in the amount of associated semantic information. Despite the crucial role of meaning in language, it is still unclear whether and how this variability modulates language learning. Here, we provide initial evidence demonstrating that implicit learning in repetition priming is influenced by the amount of semantic features…

Evidence Items as Signals of Marketing Competencies and Workplace Readiness: A Practitioner Perspective

ERIC Educational Resources Information Center

Honea, Heather; Castro, Iana A.; Peter, Paula

2017-01-01

Although past research has spent considerable effort identifying competencies and academic activities that are associated with workplace readiness, the literature is largely silent regarding what might best serve as evidence to employers that a graduate possesses specific marketing competencies. In the current research, we develop a comprehensive…

Evidence-Based Professional Development Considerations along the School-to-Prison Pipeline

ERIC Educational Resources Information Center

Houchins, David E.; Shippen, Margaret E.; Murphy, Kristin M.

2012-01-01

This article addresses professional development (PD) issues for those who provide services to students in the school-to-prison pipeline (STPP). Emphasis is on implementing evidence-based practices. The authors use a modified version of Desimone's PD framework for the structure of this article involving (a) collective participation and common…

Eco-Health Linkages: evidence base and socio-economic considerations for linking ecosystem goods and services to human health

EPA Science Inventory

Ecosystem goods and services (EGS) are thought to play a role in protecting human health, but the empirical evidence directly linking EGS to human health outcomes is limited, and our ability to detect Eco-Health linkages is confounded by socio-economic factors. These limitations ...

General instability criterion of laminar velocity distributions

NASA Technical Reports Server (NTRS)

Tollmien, W

1936-01-01

The present paper describes the results of a stability investigation on symmetrical velocity profiles in a channel and of boundary-layer profiles. The effect of friction was assumed to be vanishing and did not occur in the stability consideration so far as it had been resorted to for preparatory asymptotic considerations. Proceeding on very general premises as regards the form of the velocity distribution, a proof was deduced of the elementary theorem that velocity profiles with inflection points are unstable.

Challenges in acute heart failure clinical management: optimizing care despite incomplete evidence and imperfect drugs.

PubMed

Teichman, Sam L; Maisel, Alan S; Storrow, Alan B

2015-03-01

Acute heart failure is a common condition associated with considerable morbidity, mortality, and cost. However, evidence-based data on treating heart failure in the acute setting are limited, and current individual treatment options have variable efficacy. The healthcare team must often individualize patient care in ways that may extend beyond available clinical guidelines. In this review, we address the question, "How do you do the best you can clinically with incomplete evidence and imperfect drugs?" Expert opinion is provided to supplement guideline-based recommendations and help address the typical challenges that are involved in the management of patients with acute heart failure. Specifically, we discuss 4 key areas that are important in the continuum of patient care: differential diagnosis and risk stratification; choice and implementation of initial therapy; assessment of the adequacy of therapy during hospitalization or observation; and considerations for discharge/transition of care. A case study is presented to highlight the decision-making process throughout each of these areas. Evidence is accumulating that should help guide patients and healthcare providers on a path to better quality of care.

46 CFR 195.11-10 - Design and construction of portable vans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... consideration of forces and environmental conditions to which the structure, attachments, and attachment points... provide increased accommodation and related spaces of a temporary nature aboard a vessel. They shall...

46 CFR 195.11-10 - Design and construction of portable vans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... consideration of forces and environmental conditions to which the structure, attachments, and attachment points... provide increased accommodation and related spaces of a temporary nature aboard a vessel. They shall...

77 FR 7566 - Pacific Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... be held at the DoubleTree Hotel Sacramento, 2001 Point West Way, Sacramento, CA 95815; telephone... Plan Consideration for Sacramento River Fall Chinook and Strait of Juan de Fuca Coho 4. Identification...

N. Chomsky am Wendepunkt (N. Chomsky at the Turning Point)?

ERIC Educational Resources Information Center

Weisgerber, Leo

1971-01-01

Questions Chomsky's postulation of an innate capacity for language use, and suggests that Chomsky is modifying his theory by including the time factor in his consideration of language acquisition. (RS)

46 CFR 195.11-10 - Design and construction of portable vans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... consideration of forces and environmental conditions to which the structure, attachments, and attachment points will be exposed. (b) Steel, aluminum or other substantial material suitable for a marine environment...

46 CFR 195.11-10 - Design and construction of portable vans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... consideration of forces and environmental conditions to which the structure, attachments, and attachment points will be exposed. (b) Steel, aluminum or other substantial material suitable for a marine environment...

46 CFR 195.11-10 - Design and construction of portable vans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... consideration of forces and environmental conditions to which the structure, attachments, and attachment points will be exposed. (b) Steel, aluminum or other substantial material suitable for a marine environment...

Alternate working fluids for solar air conditioning applications

NASA Technical Reports Server (NTRS)

Evans, R. D.; Beck, J. K.

1978-01-01

An experimental investigation of sixteen different refrigerant-absorbent fluid pairs has been carried out in order to determine their suitability as the working fluid in a solar-powered absorption cycle air conditioner. The criteria used in the initial selection of a refrigerant-absorbent pair included: high affinity (large negative deviation from Raoult's Law), high solubility, low specific heat, low viscosity, stability, corrosive properties, safety, and cost. For practical solar considerations of a fluid pair, refrigerants were selected with low boiling points whereas absorbent fluids were selected with a boiling point considerably above that of the refrigerant. Additional restrictions are determined by the operating temperatures of the absorber and the generator; these temperatures were specified as 100 F (39 C) and 170 F (77 C). Data are presented for a few selected pressures at the specified absorber and generator temperatures.

Validation of Model Simulations of Anvil Cirrus Properties During TWP-ICE: Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zipser, Edward J.

2013-05-20

This 3-year grant, with two extensions, resulted in a successful 5-year effort, led by Ph.D. student Adam Varble, to compare cloud resolving model (CRM) simulations with the excellent database obtained during the TWP-ICE field campaign. The objective, largely achieved, is to undertake these comparisons comprehensively and quantitatively, informing the community in ways that goes beyond pointing out errors in the models, but points out ways to improve both cloud dynamics and microphysics parameterizations in future modeling efforts. Under DOE support, Adam Varble, with considerable assistance from Dr. Ann Fridlind and others, entrained scientists who ran some 10 different CRMs andmore » 4 different limited area models (LAMs) using a variety of microphysics parameterizations, to ensure that the conclusions of the study will have considerable generality.« less

Developing clinical practice guidelines for Chinese herbal treatment of polycystic ovary syndrome: A mixed-methods modified Delphi study.

PubMed

Lai, Lily; Flower, Andrew; Moore, Michael; Lewith, George

2015-06-01

Preliminary evidence suggests Chinese herbal medicine (CHM) could be a viable treatment option for polycystic ovary syndrome (PCOS). Prior to conducting a clinical trial it is important to consider the characteristics of good clinical practice. This study aims to use professional consensus to establish good clinical practice guidelines for the CHM treatment of PCOS. CHM practitioners participated in a mixed-methods modified Delphi study involving three rounds of structured group communication. Round 1 involved qualitative interviews with practitioners to generate statements regarding good clinical practice. In round 2, these statements were distributed online to the same practitioners to rate their agreement using a 7-point Likert scale, where group consensus was defined as a median rating of ≥5. Statements reaching consensus were accepted for consideration onto the guideline whilst those not reaching consensus were re-distributed for consideration in round 3. Statements presented in the guidelines were graded from A (strong consensus) to D (no consensus) determined by median score and interquartile range. 11 CHM practitioners in the UK were recruited. After three Delphi rounds, 91 statement items in total had been considered, of which 89 (97.8%) reached consensus and 2 (2.2%) did not. The concluding set of guidelines consists of 85 items representing key features of CHM prescribing for PCOS. These guidelines can be viewed as an initial framework that captures fundamental principles of good clinical practice for CHM. Copyright © 2015 Elsevier Ltd. All rights reserved.

Multivariate meta-analysis: potential and promise.

PubMed

Jackson, Dan; Riley, Richard; White, Ian R

2011-09-10

The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day 'Multivariate meta-analysis' event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd.

Multivariate meta-analysis: Potential and promise

PubMed Central

Jackson, Dan; Riley, Richard; White, Ian R

2011-01-01

The multivariate random effects model is a generalization of the standard univariate model. Multivariate meta-analysis is becoming more commonly used and the techniques and related computer software, although continually under development, are now in place. In order to raise awareness of the multivariate methods, and discuss their advantages and disadvantages, we organized a one day ‘Multivariate meta-analysis’ event at the Royal Statistical Society. In addition to disseminating the most recent developments, we also received an abundance of comments, concerns, insights, critiques and encouragement. This article provides a balanced account of the day's discourse. By giving others the opportunity to respond to our assessment, we hope to ensure that the various view points and opinions are aired before multivariate meta-analysis simply becomes another widely used de facto method without any proper consideration of it by the medical statistics community. We describe the areas of application that multivariate meta-analysis has found, the methods available, the difficulties typically encountered and the arguments for and against the multivariate methods, using four representative but contrasting examples. We conclude that the multivariate methods can be useful, and in particular can provide estimates with better statistical properties, but also that these benefits come at the price of making more assumptions which do not result in better inference in every case. Although there is evidence that multivariate meta-analysis has considerable potential, it must be even more carefully applied than its univariate counterpart in practice. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21268052

[The nursing profession regarding limitation of life support treatment in the intensive care units. Technical and practical features].

PubMed

Falcó-Pegueroles, A

2009-01-01

The scientific and technical developments in medicine in the recent decades have greatly helped to increase life expectancy and quality of life of many patients. In hospitals, this technological scenario has clearly influenced patient care, for example, in the Intensive Medicine Departments, leading to new clinical perspectives and has made the growing complexity of giving treatment and making decisions more evident. In some cases, it is difficult to predict how beneficial intensive medical care can be when there is no reasonable prospect of improving the patient's health, prolonging their life in situations with poor prognosis or dramatically reducing their quality of life. The clinical diagnosis of irreversibility, through indicators of severity and principles of beneficence, autonomy and justice in the professional conduct are the elements that give rise to the consideration of withholding and withdrawing treatment in the critical patient. However, there are other factors that need to be taken into consideration and that are analyzed by professional ethics and bioethics. It is from this approach that any decision involving withholding and withdrawing treatment should be taken so that these decisions can be considered estimable form an ethical point of view. The nursing professional in intensive care units is expected to actively participate in decision making by contributing with their humanizing vision and care ethics. They should be aware of their contribution in the medical team behaving, representing and encouraging the requirements of bioethics.

Considerations for protein intake in managing weight loss in athletes.

PubMed

Murphy, Caoileann H; Hector, Amy J; Phillips, Stuart M

2015-01-01

A large body of evidence now shows that higher protein intakes (2-3 times the protein Recommended Dietary Allowance (RDA) of 0.8 g/kg/d) during periods of energy restriction can enhance fat-free mass (FFM) preservation, particularly when combined with exercise. The mechanisms underpinning the FFM-sparing effect of higher protein diets remain to be fully elucidated but may relate to the maintenance of the anabolic sensitivity of skeletal muscle to protein ingestion. From a practical point of view, athletes aiming to reduce fat mass and preserve FFM should be advised to consume protein intakes in the range of ∼1.8-2.7 g kg(-1) d(-1) (or ∼2.3-3.1 g kg(-1) FFM) in combination with a moderate energy deficit (-500 kcal) and the performance of some form of resistance exercise. The target level of protein intake within this recommended range requires consideration of a number of case-specific factors including the athlete's body composition, habitual protein intake and broader nutrition goals. Athletes should focus on consuming high-quality protein sources, aiming to consume protein feedings evenly spaced throughout the day. Post-exercise consumption of 0.25-0.3 g protein meal(-1) from protein sources with high leucine content and rapid digestion kinetics (i.e. whey protein) is recommended to optimise exercise-induced muscle protein synthesis. When protein is consumed as part of a mixed macronutrient meal and/or before bed slightly higher protein doses may be optimal.

Reconstitution of the human biome as the most reasonable solution for epidemics of allergic and autoimmune diseases.

PubMed

Bilbo, Staci D; Wray, Gregory A; Perkins, Sarah E; Parker, William

2011-10-01

A wide range of hyperimmune-associated diseases plague post-industrial society, with a prevalence and impact that is staggering. Strong evidence points towards a loss of helminths from the ecosystem of the human body (the human biome) as the most important factor in this epidemic. Helminths, intestinal worms which are largely eradicated by elements of post-industrial culture including toilets and water treatment facilities, have an otherwise ubiquitous presence in vertebrates, and have co-evolved with the immune system. Not only do helminths discourage allergic and autoimmune reactions by diverting the immune system away from these pathologic processes and stimulating host regulatory networks, helminths release a variety of factors which down-modulate the immune system. A comprehensive view of hyperimmune-related disease based on studies in immunology, parasitology, evolutionary biology, epidemiology, and neurobiology indicates that the effects of biome depletion may not yet be fully realized, and may have an unexpectedly broad impact on many areas of human biology, including cognition. Fortunately, colonization with helminths results in a cure of numerous autoimmune and allergic diseases in laboratory rodents, and clinical studies in humans have indicated their utility for treatment of both multiple sclerosis and inflammatory bowel disease. Based on these considerations, commitment of considerable resources toward understanding the effects of "biome depletion" and systematically evaluating the most effective approach toward biome reconstitution is strongly encouraged. Copyright © 2011 Elsevier Ltd. All rights reserved.

Closing the chasm between research and practice: evidence of and for change.

PubMed

Green, Lawrence W

2014-04-01

The usual remedy suggested for bridging the science-to-practice gap is to improve the efficiency of disseminating the evidence-based practices to practitioners. This reflection on the gap takes the position that it is the relevance and fit of the evidence with the majority of practices that limit its applicability and application in health promotion and related behavioural, community and population-level interventions where variations in context, values and norms make uniform interventions inappropriate. To make the evidence more relevant and actionable to practice settings and populations will require reforms at many points in the research-to-practice pipeline. These points in the pipeline are described and remedies for them suggested.

Navigating the challenges of digital health innovation: considerations and solutions in developing online and smartphone-application-based interventions for mental health disorders.

PubMed

Hill, Claire; Martin, Jennifer L; Thomson, Simon; Scott-Ram, Nick; Penfold, Hugh; Creswell, Cathy

2017-08-01

This article presents an analysis of challenges and considerations when developing digital mental health innovations. Recommendations include collaborative working between clinicians, researchers, industry and service users in order to successfully navigate challenges and to ensure e-therapies are engaging, acceptable, evidence based, scalable and sustainable. © The Royal College of Psychiatrists 2017.

Integrating and evaluating sex and gender in health research.

PubMed

Day, Suzanne; Mason, Robin; Lagosky, Stephanie; Rochon, Paula A

2016-10-10

Both sex (biological factors) and gender (socio-cultural factors) shape health. To produce the best possible health research evidence, it is essential to integrate sex and gender considerations throughout the research process. Despite growing recognition of the importance of these factors, progress towards sex and gender integration as standard practice has been both slow and uneven in health research. In this commentary, we examine the challenges of integrating sex and gender from the research perspective, as well as strategies that can be used by researchers, funders and journal editors to address these challenges. Barriers to the integration of sex and gender in health research include problems with inconsistent terminology, difficulties in applying the concepts of sex and gender, failure to recognise the impact of sex and gender, and challenges with data collection and datasets. We analyse these barriers as strategic points of intervention for improving the integration of sex and gender at all stages of the research process. To assess the relative success of these strategies in any given study, researchers, funders and journal editors would benefit from a tool to evaluate the quality of sex and gender integration in order to establish benchmarks in research excellence. These assessment tools are needed now amidst growing institutional recognition that both sex and gender are necessary elements for advancing the quality and utility of health research evidence.

NR2A contributes to genesis and propagation of cortical spreading depression in rats.

PubMed

Bu, Fan; Du, Ruoxing; Li, Yi; Quinn, John P; Wang, Minyan

2016-03-22

Cortical spreading depression (CSD) is a transient propagating excitation of synaptic activity followed by depression, which is implicated in migraine. Increasing evidence points to an essential role of NR2A-containing NMDA receptors in CSD propagation in vitro; however, whether these receptors mediate CSD genesis in vivo requires clarification and the role of NR2A on CSD propagation is still under debate. Using in vivo CSD in rats with electrophysiology and in vitro CSD in chick retina with intrinsic optical imaging, we addressed the role of NR2A in CSD. We demonstrated that NVP-AAM077, a potent antagonist for NR2A-containing receptors, perfused through microdialysis probes, markedly reduced cortex susceptibility to CSD, but also reduced magnitude of CSD genesis in rats. Additionally, NVP-AAM077 at 0.3 nmol perfused into the contralateral ventricle, considerably suppressed the magnitude of CSD propagation wave and propagation rate in rats. This reduction in CSD propagation was also observed with TCN-201, a negative allosteric modulator selective for NR2A, at 3 μM, in the chick retina. Our data provides strong evidence that NR2A subunit contributes to CSD genesis and propagation, suggesting drugs selectively antagonizing NR2A-containing receptors might constitute a highly specific strategy treating CSD associated migraine with a likely better safety profile.

NR2A contributes to genesis and propagation of cortical spreading depression in rats

PubMed Central

Bu, Fan; Du, Ruoxing; Li, Yi; Quinn, John P; Wang, Minyan

2016-01-01

Cortical spreading depression (CSD) is a transient propagating excitation of synaptic activity followed by depression, which is implicated in migraine. Increasing evidence points to an essential role of NR2A-containing NMDA receptors in CSD propagation in vitro; however, whether these receptors mediate CSD genesis in vivo requires clarification and the role of NR2A on CSD propagation is still under debate. Using in vivo CSD in rats with electrophysiology and in vitro CSD in chick retina with intrinsic optical imaging, we addressed the role of NR2A in CSD. We demonstrated that NVP-AAM077, a potent antagonist for NR2A-containing receptors, perfused through microdialysis probes, markedly reduced cortex susceptibility to CSD, but also reduced magnitude of CSD genesis in rats. Additionally, NVP-AAM077 at 0.3 nmol perfused into the contralateral ventricle, considerably suppressed the magnitude of CSD propagation wave and propagation rate in rats. This reduction in CSD propagation was also observed with TCN-201, a negative allosteric modulator selective for NR2A, at 3 μM, in the chick retina. Our data provides strong evidence that NR2A subunit contributes to CSD genesis and propagation, suggesting drugs selectively antagonizing NR2A-containing receptors might constitute a highly specific strategy treating CSD associated migraine with a likely better safety profile. PMID:27001011

Evidence for late Pliocene deglacial megafloods in the Gulf of Mexico

NASA Astrophysics Data System (ADS)

Wang, Z.; Gani, M. R.

2017-12-01

The paleoclimatic significance of giant sedimentary structures developed under unconfined Froude-supercritical sediment gravity flows in subaqueous settings is considerably under-examined. This research, for the first time, extensively documents >20-km-wide and 200-m-thick Plio-Pleistocene giant sediment waves in the northern Gulf of Mexico continental slope using 3D seismic data, showing waveform morphology in unprecedented detail. Published biostratigraphic data help constraining the geologic age of these deposits. The results of numerical and morphological analyses suggest that such large-scale bedforms were formed under sheet-like unconfined Froude-supercritical turbidity currents as cyclic steps. Paleohydraulic reconstruction (e.g., flow velocity, discharge, and unit flux), in association with other evidence like geologic age, published stable isotope records, and temporal rarity, points out that the responsible Froude-supercritical turbidity currents were most likely triggered by deglacial catastrophic outburst floods during the late Pliocene to early Pleistocene. Laurentide Ice Sheet outburst floods to the Gulf of Mexico have previously been documented based mainly on deep-sea cores during the last several interglacial episodes in the late Pleistocene. Our megaflood events constitute, by far, the oldest record of the glacial outburst floods during the Quaternary Ice Age anywhere in the world. This study suggests that such pervasive occurrence of large-scale sediment waves likely serve as a proxy for extreme events like catastrophic megafloods.

Interpretation of the margin of exposure for genotoxic carcinogens - elicitation of expert knowledge about the form of the dose response curve at human relevant exposures.

PubMed

Boobis, Alan; Flari, Villie; Gosling, John Paul; Hart, Andy; Craig, Peter; Rushton, Lesley; Idahosa-Taylor, Ehi

2013-07-01

The general approach to risk assessment of genotoxic carcinogens has been to advise reduction of exposure to "as low as reasonably achievable/practicable" (ALARA/P). However, whilst this remains the preferred risk management option, it does not provide guidance on the urgency or extent of risk management actions necessary. To address this, the "Margin of Exposure" (MOE) approach has been proposed. The MOE is the ratio between the point of departure for carcinogenesis and estimated human exposure. However, interpretation of the MOE requires implicit or explicit consideration of the shape of the dose-response curve at human relevant exposures. In a structured elicitation exercise, we captured expert opinion on available scientific evidence for low dose-response relationships for genotoxic carcinogens. This allowed assessment of: available evidence for the nature of dose-response relationships at human relevant exposures; the generality of judgments about such dose-response relationships; uncertainties affecting judgments on the nature of such dose-response relationships; and whether this last should differ for different classes of genotoxic carcinogens. Elicitation results reflected the variability in experts' views on the form of the dose-response curve for low dose exposure and major sources of uncertainty affecting the assumption of a linear relationship. Copyright © 2013 Elsevier Ltd. All rights reserved.

Associations of work stress with hair cortisol concentrations - initial findings from a prospective study.

PubMed

Herr, Raphael M; Almer, Christian; Loerbroks, Adrian; Barrech, Amira; Elfantel, Irina; Siegrist, Johannes; Gündel, Harald; Angerer, Peter; Li, Jian

2018-03-01

There is ample evidence supporting the link between stress at the workplace and physical and mental health. One of the pathways potentially mediating those associations may involve the hypothalamic-pituitary-adrenal (HPA) axis, with cortisol as an end product. While theoretically plausible, findings on the association of self-reported work stress with hair cortisol concentrations (HCC) are inconclusive, being potentially biased by omitted pertinent factors. This issue can be addressed, among others, by eliminating time-invariant factors through consideration of variation within persons over time. To this end, the present study examined the association between variation in HCC and perceived work stress - as assessed by the Effort-Reward-Imbalance (ERI) model - between two points in time (t1 and t2) over one year in a sample of 40 male factory workers. Neither a cross-sectional association, nor a link between change in ERI and HCC levels at t2 was observed. There was however a robust association of the change in ERI with the change of HCC. This effect was independent of baseline HCC and other confounders (Beta = 0.414, S.E. = 0.155, p = 0.012). Accordingly, this is the first study revealing prospective evidence for the associations of work stress with HCC, while excluding potentially time-stable confounding factors, like genetic factors or phenotypic hair color. Copyright © 2018 Elsevier Ltd. All rights reserved.

Spinal manipulation under anesthesia: a narrative review of the literature and commentary

PubMed Central

2013-01-01

As exhibited throughout the medical literature over many decades, there is a lack of uniformity in the manner in which spine pain patients have historically qualified for and received manipulation under anesthesia (MUA). Also, for different professions that treat the same types of spinal conditions via the same means, fundamental MUA decision points vary within the published protocols of different professional associations. The more recent chiropractic literature communicates that the evidence to support the efficacy of MUA of the spine remains largely anecdotal. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. This article will provide a narrative review of the MUA literature, followed by a commentary about the current lack of high quality research evidence, the anecdotal and consensus basis of existing clinical protocols, as well as related professional, ethical and legal concerns for the chiropractic practitioner. The limitations of the current medical literature related to MUA via conscious/deep sedation need to be recognized and used as a guide to clinical experience when giving consideration to this procedure. More research, in the form of controlled clinical trials, must be undertaken if this procedure is to remain a potential treatment option for chronic spine pain patients in the chiropractic clinical practice. PMID:23672974

Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome

PubMed Central

de Bortoli, Nicola; Martinucci, Irene; Bellini, Massimo; Savarino, Edoardo; Savarino, Vincenzo; Blandizzi, Corrado; Marchi, Santino

2013-01-01

Several studies indicate a significant degree of overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). Likewise, both functional heartburn (FH) and IBS are functional digestive disorders that may occur in the same patients. However, data establishing a solid link between FH and IBS are lacking, mainly because the clinical definition of FH has undergone substantial changes over the years. The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS. In particular, several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH (as defined by the Rome III criteria) from GERD via pathophysiological investigations. Independent of these critical issues, there is preliminary evidence supporting a significant degree of FH-IBS overlap. This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications, particularly to distinguish FH from GERD. This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders. PMID:24124323

Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome.

PubMed

de Bortoli, Nicola; Martinucci, Irene; Bellini, Massimo; Savarino, Edoardo; Savarino, Vincenzo; Blandizzi, Corrado; Marchi, Santino

2013-09-21

Several studies indicate a significant degree of overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). Likewise, both functional heartburn (FH) and IBS are functional digestive disorders that may occur in the same patients. However, data establishing a solid link between FH and IBS are lacking, mainly because the clinical definition of FH has undergone substantial changes over the years. The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS. In particular, several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH (as defined by the Rome III criteria) from GERD via pathophysiological investigations. Independent of these critical issues, there is preliminary evidence supporting a significant degree of FH-IBS overlap. This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications, particularly to distinguish FH from GERD. This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.

Clinician-Reported Outcome Assessments of Treatment Benefit: Report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force

PubMed Central

Powers, John H.; Patrick, Donald L.; Walton, Marc K.; Marquis, Patrick; Cano, Stefan; Hobart, Jeremy; Isaac, Maria; Vamvakas, Spiros; Slagle, Ashley; Molsen, Elizabeth; Burke, Laurie B.

2017-01-01

A clinician-reported outcome (ClinRO) assessment is a type of clinical outcome assessment (COA). ClinRO assessments, like all COAs (patient-reported, observer-reported, or performance outcome assessments), are used to 1) measure patients’ health status and 2) define end points that can be interpreted as treatment benefits of medical interventions on how patients feel, function, or survive in clinical trials. Like other COAs, ClinRO assessments can be influenced by human choices, judgment, or motivation. A ClinRO assessment is conducted and reported by a trained health care professional and requires specialized professional training to evaluate the patient’s health status. This is the second of two reports by the ISPOR Clinical Outcomes Assessment—Emerging Good Practices for Outcomes Research Task Force. The first report provided an overview of COAs including definitions important for an understanding of COA measurement practices. This report focuses specifically on issues related to ClinRO assessments. In this report, we define three types of ClinRO assessments (readings, ratings, and clinician global assessments) and describe emerging good measurement practices in their development and evaluation. The good measurement practices include 1) defining the context of use; 2) identifying the concept of interest measured; 3) defining the intended treatment benefit on how patients feel, function, or survive reflected by the ClinRO assessment and evaluating the relationship between that intended treatment benefit and the concept of interest; 4) documenting content validity; 5) evaluating other measurement properties once content validity is established (including intra- and inter-rater reliability); 6) defining study objectives and end point(s) objectives, and defining study end points and placing study end points within the hierarchy of end points; 7) establishing interpretability in trial results; and 8) evaluating operational considerations for the implementation of ClinRO assessments used as end points in clinical trials. Applying good measurement practices to ClinRO assessment development and evaluation will lead to more efficient and accurate measurement of treatment effects. This is important beyond regulatory approval in that it provides evidence for the uptake of new interventions into clinical practice and provides justification to payers for reimbursement on the basis of the clearly demonstrated added value of the new intervention. PMID:28212963

Clinician-Reported Outcome Assessments of Treatment Benefit: Report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force.

PubMed

Powers, John H; Patrick, Donald L; Walton, Marc K; Marquis, Patrick; Cano, Stefan; Hobart, Jeremy; Isaac, Maria; Vamvakas, Spiros; Slagle, Ashley; Molsen, Elizabeth; Burke, Laurie B

2017-01-01

A clinician-reported outcome (ClinRO) assessment is a type of clinical outcome assessment (COA). ClinRO assessments, like all COAs (patient-reported, observer-reported, or performance outcome assessments), are used to 1) measure patients' health status and 2) define end points that can be interpreted as treatment benefits of medical interventions on how patients feel, function, or survive in clinical trials. Like other COAs, ClinRO assessments can be influenced by human choices, judgment, or motivation. A ClinRO assessment is conducted and reported by a trained health care professional and requires specialized professional training to evaluate the patient's health status. This is the second of two reports by the ISPOR Clinical Outcomes Assessment-Emerging Good Practices for Outcomes Research Task Force. The first report provided an overview of COAs including definitions important for an understanding of COA measurement practices. This report focuses specifically on issues related to ClinRO assessments. In this report, we define three types of ClinRO assessments (readings, ratings, and clinician global assessments) and describe emerging good measurement practices in their development and evaluation. The good measurement practices include 1) defining the context of use; 2) identifying the concept of interest measured; 3) defining the intended treatment benefit on how patients feel, function, or survive reflected by the ClinRO assessment and evaluating the relationship between that intended treatment benefit and the concept of interest; 4) documenting content validity; 5) evaluating other measurement properties once content validity is established (including intra- and inter-rater reliability); 6) defining study objectives and end point(s) objectives, and defining study end points and placing study end points within the hierarchy of end points; 7) establishing interpretability in trial results; and 8) evaluating operational considerations for the implementation of ClinRO assessments used as end points in clinical trials. Applying good measurement practices to ClinRO assessment development and evaluation will lead to more efficient and accurate measurement of treatment effects. This is important beyond regulatory approval in that it provides evidence for the uptake of new interventions into clinical practice and provides justification to payers for reimbursement on the basis of the clearly demonstrated added value of the new intervention. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Dry needling — peripheral and central considerations

PubMed Central

Dommerholt, Jan

2011-01-01

Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture. PMID:23115475

Computing Maximally Supersymmetric Scattering Amplitudes

NASA Astrophysics Data System (ADS)

Stankowicz, James Michael, Jr.

This dissertation reviews work in computing N = 4 super-Yang--Mills (sYM) and N = 8 maximally supersymmetric gravity (mSUGRA) scattering amplitudes in D = 4 spacetime dimensions in novel ways. After a brief introduction and overview in Ch. 1, the various techniques used to construct amplitudes in the remainder of the dissertation are discussed in Ch. 2. This includes several new concepts such as d log and pure integrand bases, as well as how to construct the amplitude using exactly one kinematic point where it vanishes. Also included in this chapter is an outline of the Mathematica package on shell diagrams and numerics.m (osdn) that was developed for the computations herein. The rest of the dissertation is devoted to explicit examples. In Ch. 3, the starting point is tree-level sYM amplitudes that have integral representations with residues that obey amplitude relations. These residues are shown to have corresponding residue numerators that allow a double copy prescription that results in mSUGRA residues. In Ch. 4, the two-loop four-point sYM amplitude is constructed in several ways, showcasing many of the techniques of Ch. 2; this includes an example of how to use osdn. The two-loop five-point amplitude is also presented in a pure integrand representation with comments on how it was constructed from one homogeneous cut of the amplitude. On-going work on the two-loop n-point amplitude is presented at the end of Ch. 4. In Ch. 5, the three-loop four-point amplitude is presented in the d log representation and in the pure integrand representation. In Ch. 6, there are several examples of four- through seven-loop planar diagrams that illustrate how considerations of the singularity structure of the amplitude underpin dual-conformal invariance. Taken with the previous examples, this is additional evidence that the structure known to exist in the planar sector extends to the full theory. At the end of this chapter is a proof that all mSUGRA amplitudes have a pole at infinity for (L ≥ 4)-loops. Finally in Ch. 7, the current status of ultraviolet divergences in the five-loop four-point mSUGRA amplitude is addressed. This includes a discussion of ongoing work aimed at resolving the mSUGRA finiteness question. The following Mathematica scripts are submitted with this dissertation: • on shell diagrams and numerics.m with dependencies: -- all_trees *.m -- external_kinematics_*_point.m -- rational_external_*_point.m where "*" is a wild-card string of any set of characters of any length -- either an integer or a number spelled out.

Mode of action human relevance (species concordance) framework: Evolution of the Bradford Hill considerations and comparative analysis of weight of evidence

PubMed Central

Meek, M E (Bette); Palermo, Christine M; Bachman, Ammie N; North, Colin M; Jeffrey Lewis, R

2014-01-01

The mode of action human relevance (MOA/HR) framework increases transparency in systematically considering data on MOA for end (adverse) effects and their relevance to humans. This framework continues to evolve as experience increases in its application. Though the MOA/HR framework is not designed to address the question of “how much information is enough” to support a hypothesized MOA in animals or its relevance to humans, its organizing construct has potential value in considering relative weight of evidence (WOE) among different cases and hypothesized MOA(s). This context is explored based on MOA analyses in published assessments to illustrate the relative extent of supporting data and their implications for dose–response analysis and involved comparisons for chemical assessments on trichloropropane, and carbon tetrachloride with several hypothesized MOA(s) for cancer. The WOE for each hypothesized MOA was summarized in narrative tables based on comparison and contrast of the extent and nature of the supporting database versus potentially inconsistent or missing information. The comparison was based on evolved Bradford Hill considerations rank ordered to reflect their relative contribution to WOE determinations of MOA taking into account increasing experience in their application internationally. This clarification of considerations for WOE determinations as a basis for comparative analysis is anticipated to contribute to increasing consistency in the application of MOA/HR analysis and potentially, transparency in separating science judgment from public policy considerations in regulatory risk assessment. Copyright © 2014. The Authors. Journal of Applied Toxicology Published by John Wiley & Sons Ltd. The potential value of the mode of action (MOA)/human relevance (species concordance) framework in considering relative weight of evidence (WOE) amongst different cases and hypothesized MOA(s) is explored based on the content of several published assessments. The comparison is based on evolved Bradford Hill considerations rank ordered to reflect their relative contribution to WOE determinations for MOA based on experience internationally. PMID:24777878

Should the Equilibrium Point Hypothesis (EPH) be Considered a Scientific Theory?

PubMed Central

Sainburg, Robert L.

2017-01-01

The purpose of this commentary is to discuss factors that limit consideration of the equilibrium point hypothesis as a scientific theory. The EPH describes control of motor neuron threshold through the variable lambda, which corresponds to a unique referent configuration for a muscle, joint, or combination of joints. One of the most compelling features of the equilibrium point hypothesis is the integration of posture and movement control into a single mechanism. While the essential core of the hypothesis is based upon spinal circuitry interacting with peripheral mechanics, the proponents have extended the theory to include the higher-level processes that generate lambda, and in doing so, imposed an injunction against the supraspinal nervous system modeling, computing, or predicting dynamics. This limitation contradicts evidence that humans take account of body and environmental dynamics in motor selection, motor control, and motor adaptation processes. A number of unresolved limitations to the EPH have been debated in the literature for many years, including whether muscle resistance to displacement, measured during movement, is adequate to support this form of control, violations in equifinality predictions, spinal circuits that alter the proposed invariant characteristic for muscles, and limitations in the description of how the complexity of spinal circuitry might be integrated to yield a unique and stable equilibrium position for a given motor neuron threshold. In addition, an important empirical limitation of EPH is the measurement of the invariant characteristic, which needs to be done under a constant central state. While there is no question that the EPH is an elegant and generative hypothesis for motor control research, the claim that this hypothesis has reached the status of a scientific theory is premature. PMID:25386681

Should the Equilibrium Point Hypothesis (EPH) be Considered a Scientific Theory?

PubMed

Sainburg, Robert L

2015-04-01

The purpose of this commentary is to discuss factors that limit consideration of the equilibrium point hypothesis as a scientific theory. The EPH describes control of motor neuron threshold through the variable lambda, which corresponds to a unique referent configuration for a muscle, joint, or combination of joints. One of the most compelling features of the equilibrium point hypothesis is the integration of posture and movement control into a single mechanism. While the essential core of the hypothesis is based upon spinal circuitry interacting with peripheral mechanics, the proponents have extended the theory to include the higher-level processes that generate lambda, and in doing so, imposed an injunction against the supraspinal nervous system modeling, computing, or predicting dynamics. This limitation contradicts evidence that humans take account of body and environmental dynamics in motor selection, motor control, and motor adaptation processes. A number of unresolved limitations to the EPH have been debated in the literature for many years, including whether muscle resistance to displacement, measured during movement, is adequate to support this form of control, violations in equifinality predictions, spinal circuits that alter the proposed invariant characteristic for muscles, and limitations in the description of how the complexity of spinal circuitry might be integrated to yield a unique and stable equilibrium position for a given motor neuron threshold. In addition, an important empirical limitation of EPH is the measurement of the invariant characteristic, which needs to be done under a constant central state. While there is no question that the EPH is an elegant and generative hypothesis for motor control research, the claim that this hypothesis has reached the status of a scientific theory is premature.

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial.

PubMed

Kongsawatvorakul, Chompunoot; Charakorn, Chuenkamon; Paiwattananupant, Krissada; Lekskul, Navamol; Rattanasiri, Sasivimol; Lertkhachonsuk, Arb-Aroon

2016-01-01

Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.

The entry-level occupational therapy clinical doctorate: advantages, challenges, and international issues to consider.

PubMed

Brown, Ted; Crabtree, Jeffrey L; Mu, Keli; Wells, Joe

2015-04-01

Internationally, occupational therapy education has gone through several paradigm shifts during the last few decades, moving from certificate to diploma to bachelors to masters and now in some instances to clinical doctorate as the entry-level professional credential to practice. In the United States there is a recommendation under consideration by the American Occupational Therapy Association (AOTA) that by 2025, all occupational therapy university programs will move to the clinical doctorate level. It should be noted, however, that the AOTA Board can only make recommendations and it is the Accreditation Council for Occupational Therapy Education (ACOTE) who has regulatory authority to approve such a change. What are the potential implications for the profession, our clients, and funders of occupational therapy services? What are the primary drivers for the move towards the clinical doctorate being the educational entry point? Is the next step in the evolution of occupational therapy education globally a shift to the entry-level clinical doctorate? This article reviews current literature and discusses issues about the occupational therapy entry-level clinical doctorate. The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to the clinical doctorate as the singular entry point to occupational therapy practice are considered. The potential impacts of the introduction of the clinical doctorate as the entry-to-practice qualification across the United States on the occupational therapy community internationally will be briefly discussed. If the United States moves toward the entry-level clinical doctorate as the only educational starting point for the profession, will other jurisdictions follow suit? Further discourse and investigation of this issue both inside and outside of the United States is needed so that informed decisions can be made.

The United States food supply is not consistent with dietary guidance: evidence from an evaluation using the Healthy Eating Index-2010

PubMed Central

Miller, Paige E; Reedy, Jill; Kirkpatrick, Sharon I

2014-01-01

The United States (U.S.) food system is primarily an economic enterprise, with far-reaching health, environmental, and social effects. A key data source for evaluating the many effects of the food system, including the overall quality and extent to which it provides the basic elements of a healthful diet, is the Food Availability Data System. The objective of the present study was to update earlier research that evaluated the extent to which the U.S. food supply aligns with the most recent Federal dietary guidance, using the current Healthy Eating Index (HEI)-2010 and food supply data extending through 2010. The HEI-2010 was applied to 40 years of food supply data (1970–2010) to examine trends in the overall food supply as well as specific components related to a healthy diet, such as fruits and vegetables. The HEI-2010 overall summary score hovered around half of optimal for all years evaluated, with an increase from 48 points in 1970 to 55 points (out of a possible 100 points) in 2010. Fluctuations in scores for most individual components did not lead to sustained trends. The present study continues to demonstrate sizable gaps between Federal dietary guidance and the food supply. This disconnect is troublesome within a context of high rates of diet-related chronic diseases among the population and suggests the need for continual monitoring of the quality of the food supply. Moving toward a food system that is more conducive to healthy eating requires consideration of a range of factors that influence food supply and demand. PMID:25441965

[Articulata and Ecdysozoa].

PubMed

Ivanova-Kazas, O M

2015-01-01

Science has accumulated to date such amounts of valuable and diverse information that no scientists can be encyclopedists (like those of the 17th and 18th centuries). Now every scientist is usually well informed only in one particular area and often needs consultations of other specialists. The current situation in biology is similar. In addition to evolutionary morphology, which represents fundamentals of zoology, there is a new, clearly cutting-edge and progressive area of studies, molecular genetics, which has already revealed many important general biological patterns. But the conclusions that follow from examining natural phenomena from this new point of view using new methods sometimes prove to be at odds with conventional notions. Considerable controversies have emerged on the phylogenetic position of the type Arthropoda. The peculiar features of the general body plan and the type of development of these animals seem to give evidence that they evolved from Annelida, with which they are often combined under the name Articulata. But attempts have been made to replace this concept by the idea that the clade Ecdysozoa, which includes Arthropods as well as such animals with low levels of organization as Nematoda and Priapulida, emerged early in the evolution of Bilateria. The main reason for combining the said animals in this clade is the fact that they have molts regulated with ecdysone; this point of view is supported by molecular genetic arguments. Although in this review this controversial problem is considered from the morphological point of view, the main purpose of the review is to emphasize the need to establish mutual understanding.between morphologists and molecular biologists and carefully find out the causes of the existing disagreements. Rather than ideological opponents, the two areas of science should be allies helping each other to solve complicated problems.

Evolution of the Li-Yu Lake at Eastern Taiwan: Evidences from Magnetic Proxies and Pollen Analysis

NASA Astrophysics Data System (ADS)

Lee, T.; Wang, L.; Chen, S.

2008-12-01

The Li-Yu Lake located at Hua-Lien County of eastern Taiwan seems to be originally a river and was trapped by a landslide to form a lake after. To investigate the truth, a lacustrine sediment core of about 8 meters was raised from the lake and magnetic proxies and pollen analysis were employed to analyze it. Based on the C- 14 dating, this core provides the information for the last 7000 years Magnetic proxies point out that the records could be clearly distinguished into two parts from the depth of about 2.6 meters : the deeper part dominates very coarse grained with higher oxidized magnetic minerals and vice versa at the shallower part. This boundary corresponds an ages of about 2300 yrB.P. Pollen analysis reveals that no pollen could be found at the depths below 2.8 meters; only aquatic plant pollens, such as Poaceae, Cyperaceae and Mynophyllum, were found at the depth between 2.8-2.5 meters; tree and shrub pollens began to appear at about 2.5 m in depth. These results proposed that sediments below 2.8 m (before 2400 yrBP) might be a river deposit; the river was blocked at its northern end to form a lake between 2300-2400 yrBP in consideration of the topography, and regular lake deposits occurred after 2300 yrBP. Furthermore, magnetic proxies were found to have a clear change during the age interval of about 900-600 yrBP. Pollen patterns also support this point. It is proposed that the river piracy might have happened at the southern area of the lake at this time. The literatures recording the human activity in this area seem to support this point of view.

Early warning of climate tipping points

NASA Astrophysics Data System (ADS)

Lenton, Timothy M.

2011-07-01

A climate 'tipping point' occurs when a small change in forcing triggers a strongly nonlinear response in the internal dynamics of part of the climate system, qualitatively changing its future state. Human-induced climate change could push several large-scale 'tipping elements' past a tipping point. Candidates include irreversible melt of the Greenland ice sheet, dieback of the Amazon rainforest and shift of the West African monsoon. Recent assessments give an increased probability of future tipping events, and the corresponding impacts are estimated to be large, making them significant risks. Recent work shows that early warning of an approaching climate tipping point is possible in principle, and could have considerable value in reducing the risk that they pose.

Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements

PubMed Central

Benmarhnia, Tarik; Huang, Jonathan Y.; Jones, Catherine M.

2017-01-01

Background: Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. Methods: We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. Results: WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. Conclusion: In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued. PMID:29179291

Pascal's wager: combining continuous glucose monitoring and continuous subcutaneous insulin infusion.

PubMed

Kerr, David; Olateju, Tolu

2010-06-01

Pascal's Wager is a suggestion posed by the French Philosopher, Blaise Pascal, that even though the existence of God cannot be determined through reason, a person should wager that God exists because he or she has everything to gain and nothing to lose. In the area of consideration here, the optimum experimental trial of the combined use of continuous subcutaneous insulin infusion and real-time continuous glucose monitoring in free-living individuals with type 1 diabetes providing rock-solid evidence of clinical benefit has not been performed. Nevertheless, there is considerable enthusiasm for combining the technologies among healthcare professionals, patients, and manufacturers based on the belief that this approach to diabetes care must be beneficial beyond the available evidence (i.e., reason).

An engineering perspective on 3D printed personalized scaffolds for tracheal suspension technique

PubMed Central

An, Jia

2016-01-01

3D printing is a large family of many distinct technologies covering a wide range of topics. From an engineering point of view, there should be considerations for selection of design, material, and process when using 3D printing for surgical technique innovation such as personalized scaffolds. Moreover, cost should also be considered if there are equally effective alternatives to the innovation. Furthermore, engineering considerations and options should be clearly communicated and readily available to surgeons for advancement in future. PMID:28149624

An engineering perspective on 3D printed personalized scaffolds for tracheal suspension technique.

PubMed

An, Jia; Chua, Chee Kai

2016-12-01

3D printing is a large family of many distinct technologies covering a wide range of topics. From an engineering point of view, there should be considerations for selection of design, material, and process when using 3D printing for surgical technique innovation such as personalized scaffolds. Moreover, cost should also be considered if there are equally effective alternatives to the innovation. Furthermore, engineering considerations and options should be clearly communicated and readily available to surgeons for advancement in future.

Paediatricians, social media and blogs: Ethical considerations.

PubMed

St-Laurent-Gagnon, Thérèse; Coughlin, Kevin W

2012-05-01

The use of blogs, Facebook and similar social networking sites is rapidly expanding and, when compared with e-mail, may be having a significantly different impact on the traditional doctor-patient relationship. Characteristics specific to these online platforms have major implications for professional relationships, including the 'Facebook effect' (the relative permanence of postings) and the 'online disinhibition effect'. The present practice point illustrates relevant ethical considerations and provides guidance to paediatricians and others concerning the prudent professional and personal use of social networking media.

Situational and Generalised Conduct Problems and Later Life Outcomes: Evidence from a New Zealand Birth Cohort

ERIC Educational Resources Information Center

Fergusson, David M.; Boden, Joseph M.; Horwood, L. John

2009-01-01

Background: There is considerable evidence suggesting that many children show conduct problems that are specific to a given context (home; school). What is less well understood is the extent to which children with situation-specific conduct problems show similar outcomes to those with generalised conduct problems. Methods: Data were gathered as…

"Serial" Effects in Parallel Models of Reading

ERIC Educational Resources Information Center

Chang, Ya-Ning; Furber, Steve; Welbourne, Stephen

2012-01-01

There is now considerable evidence showing that the time to read a word out loud is influenced by an interaction between orthographic length and lexicality. Given that length effects are interpreted by advocates of dual-route models as evidence of serial processing this would seem to pose a serious challenge to models of single word reading which…

Science and Creationism: A View from the National Academy of Sciences.

ERIC Educational Resources Information Center

National Academy of Sciences, Washington, DC.

Five central scientific issues are critical to consideration of the treatment in school curricula of the origin and evolution of the universe and of life on earth. These issues are: (1) the nature of science; (2) scientific evidence on the origin of the universe and the earth; (3) the consistent and validated scientific evidence for biological…

Differential Diagnosis of Dysgraphia, Dyslexia, and OWL LD: Behavioral and Neuroimaging Evidence

ERIC Educational Resources Information Center

Berninger, Virginia W.; Richards, Todd L.; Abbott, Robert D.

2015-01-01

In Study 1, children in grades 4-9 (N = 88, 29 females and 59 males) with persisting reading and/or writing disabilities, despite considerable prior specialized instruction in and out of school, were given an evidence-based comprehensive assessment battery at the university while parents completed questionnaires regarding past and current history…

What Does a Transformative Lens Bring to Credible Evidence in Mixed Methods Evaluations?

ERIC Educational Resources Information Center

Mertens, Donna M.

2013-01-01

Credibility in evaluation is a multifaceted concept that involves consideration of diverse stakeholders' perspectives and purposes. The use of a transformative lens is proposed as a means to bringing issues of social justice and human rights to the foreground in decisions about methodology, credibility of evidence, and use of evaluation…

Adapting Evidence-Based Mental Health Treatments in Community Settings: Preliminary Results from a Partnership Approach

ERIC Educational Resources Information Center

Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.

2009-01-01

This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…

Class Size Effects on Reading Achievement Using PIRLS Data: Evidence from Greece

ERIC Educational Resources Information Center

Konstantopoulos, Spyros; Traynor, Anne

2014-01-01

Background/Context: The effects of class size on student achievement have gained considerable attention in education research and policy, especially over the last 30 years. Perhaps the best evidence about the effects of class size thus far has been produced from analyses of Project STAR data, a large-scale experiment where students and teachers…

Mass Transfer Cooling Near The Stagnation Point

NASA Technical Reports Server (NTRS)

Roberts, Leonard

1959-01-01

A simplified analysis is made of mass transfer cooling, that is, injection of a foreign gas, near the stagnation point for two-dimensional and axisymmetric bodies. The reduction in heat transfer is given in terms of the properties of the coolant gas and it is shown that the heat transfer may be reduced considerably by the introduction of a gas having appropriate thermal and diffusive properties. The mechanism by which heat transfer is reduced is discussed.

Unmanned spacecraft for surveying earth's resources

NASA Technical Reports Server (NTRS)

George, T. A.

1970-01-01

The technical objectives and payloads for ERTS A and B are discussed. The primary emphasis is on coverage of the United States and the ocean areas immediately adjacent, using 3-camera return beam vidicon TV system, 4-channel multispectral point scanner, data collection system, and wideband video tape recorder. The expected performance and system characteristics of the RBV system and the 4-band multispectral object plane point scanner are outlined. Ground station considerations are also given.

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

PubMed Central

Selvin, Elizabeth

2016-01-01

Studies that have compared HbA1c levels by race have consistently demonstrated higher HbA1c levels in African Americans than in whites. These racial differences in HbA1c have not been explained by measured differences in glycemia, sociodemographic factors, clinical factors, access to care, or quality of care. Recently, a number of nonglycemic factors and several genetic polymorphisms that operate through nonglycemic mechanisms have been associated with HbA1c. Their distributions across racial groups and their impact on hemoglobin glycation need to be systematically explored. Thus, on the basis of evidence for racial differences in HbA1c, current clinical guidelines from the American Diabetes Association state: “It is important to take…race/ethnicity…into consideration when using the A1C to diagnose diabetes.” However, it is not clear from the guidelines how this recommendation might be actualized. So, the critical question is not whether racial differences in HbA1c exist between African Americans and whites; the important question is whether the observed differences in HbA1c level are clinically meaningful. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Herman provides his argument that the failure to acknowledge that HbA1c might be a biased measure of average glycemia and an unwillingness to rigorously investigate this hypothesis will slow scientific progress and has the potential to do great harm. In the counterpoint narrative below, Dr. Selvin argues that there is no compelling evidence for racial differences in the validity of HbA1c as a measure of hyperglycemia and that race is a poor surrogate for differences in underlying causes of disease risk. —William T. Cefalu Editor in Chief, Diabetes Care PMID:27457637

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions.

PubMed

Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J

2017-06-01

Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.

Local parametric instability near elliptic points in vortex flows under shear deformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koshel, Konstantin V., E-mail: kvkoshel@poi.dvo.ru; Institute of Applied Mathematics, FEB RAS, 7, Radio Street, Vladivostok 690022; Far Eastern Federal University, 8, Sukhanova Street, Vladivostok 690950

The dynamics of two point vortices embedded in an oscillatory external flow consisted of shear and rotational components is addressed. The region associated with steady-state elliptic points of the vortex motion is established to experience local parametric instability. The instability forces the point vortices with initial positions corresponding to the steady-state elliptic points to move in spiral-like divergent trajectories. This divergent motion continues until the nonlinear effects suppress their motion near the region associated with the steady-state separatrices. The local parametric instability is then demonstrated not to contribute considerably to enhancing the size of the chaotic motion regions. Instead, themore » size of the chaotic motion region mostly depends on overlaps of the nonlinear resonances emerging in the perturbed system.« less

A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions.

PubMed

Simopoulos, Thomas T; Manchikanti, Laxmaiah; Singh, Vijay; Gupta, Sanjeeva; Hameed, Haroon; Diwan, Sudhir; Cohen, Steven P

2012-01-01

The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature. To evaluate the accuracy of diagnostic sacroiliac joint interventions. A systematic review of diagnostic sacroiliac joint interventions. Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard. The evidence is good for the diagnosis of sacroiliac joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose sacroiliac joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited. The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of sacroiliac joint pain. Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.

A Cross-Cultural Study of Reference Point Adaptation: Evidence from China, Korea, and the US

ERIC Educational Resources Information Center

Arkes, Hal R.; Hirshleifer, David; Jiang, Danling; Lim, Sonya S.

2010-01-01

We examined reference point adaptation following gains or losses in security trading using participants from China, Korea, and the US. In both questionnaire studies and trading experiments with real money incentives, reference point adaptation was larger for Asians than for Americans. Subjects in all countries adapted their reference points more…

5 CFR 835.605 - OPM action as a result of consideration of evidence submitted as a result of the notice of intent.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Collection of Debts by Federal Tax Refund Offset § 835.605 OPM action as a result of consideration of... income tax refund, if it sustains its decision that the debt is past-due and legally enforceable. OPM... will not refer the debt to the IRS for offset against the debtor's Federal income tax refund, if it...

Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

PubMed

Koonrungsesomboon, Nut; Karbwang, Juntra

2016-10-15

Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. To review ethical issues and discuss considerations when such research is proposed. Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed. Copyright © 2015 Elsevier GmbH. All rights reserved.

Decreased pain sensitivity due to trimethylbenzene exposure ...

EPA Pesticide Factsheets

Traditionally, human health risk assessments have relied on qualitative approaches for hazard identification, often using the Hill criteria and weight of evidence determinations to integrate data from multiple studies. Recently, the National Research Council has recommended the development of quantitative approaches for evidence integration, including the application of meta-analyses. The following hazard identification case study applies qualitative as well as meta-analytic approaches to trimethylbenzene (TMB) isomers exposure and the potential neurotoxic effects on pain sensitivity. In the meta-analytic approach, a pooled effect size is calculated, after consideration of multiple confounding factors, in order to determine whether the entire database under consideration indicates that TMBs are likely to be a neurotoxic hazard. The pain sensitivity studies included in the present analyses initially seem discordant in their results: effects on pain sensitivity are seen immediately after termination of exposure, appear to resolve 24 hours after exposure, and then reappear 50 days later following foot-shock. Qualitative consideration of toxicological and toxicokinetic characteristics of the TMB isomers suggests that the observed differences between studies are due to testing time and can be explained through a complete consideration of the underlying biology of the effect and the nervous system as a whole. Meta-analyses and –regressions support this conclus

Idea Bank: Summer Music Programs for Students.

ERIC Educational Resources Information Center

Anderson, Tom; And Others

1989-01-01

Describes the elements of high quality summer music programs for students. Points out considerations for selection of a summer music camp, including setting daily schedule, amount of performance and private lessons, cost, faculty, and program scope. (LS)

CSO CONSIDERATIONS

EPA Science Inventory

Over the years, estimates of the number of CSS and CSO discharge points have fluctuated as communities changed their systems and more information became available. Early research by the US Environmental Protection Agency (US EPA) estimated that approximately 15,000 overflow poin...

Devolution and health in the UK: policy and its lessons since 1998

PubMed Central

Greer, Scott L.

2016-01-01

Introduction Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland and Wales. Sources of data Secondary literature and authors’ own research since 1998. Areas of agreement From a similar starting point, there has been a considerable distancing of the four health systems from each other in policies, priorities and organization. Areas of controversy The comparative efficiency and quality of the different systems as well as the wisdom of their greater or lesser reliance on integration and competition. Growing points Better and more comparable public data would be useful, as would consideration of potential devolved lessons for UK policy. Areas timely for developing further research Comparisons of organization and performance at levels more detailed than whole systems; analysis of the resilience and management of different systems in a context of budgetary austerity; analysis of the politics behind policy decisions. PMID:27151953

Studies on scaling of flow noise received at the stagnation point of an axisymmetric body

NASA Astrophysics Data System (ADS)

Arakeri, V. H.; Satyanarayana, S. G.; Mani, K.; Sharma, S. D.

1991-05-01

A description of the studies related to the problem of scaling of flow noise received at the stagnation point of axisymmetric bodies is provided. The source of flow noise under consideration is the transitional/turbulent regions of the boundary layer flow on the axisymmetric body. Lauchle has recently shown that the noise measured in the laminar region (including the stagnation point) corresponds closely to the noise measured in the transition region, provided that the acoustic losses due to diffraction are accounted for. The present study includes experimental measurement of flow noise at the stagnation point of three different shaped axisymmetric headforms. One of the body shapes chosen is that used by Lauchle in similar studies. This was done to establish the effect of body size on flow noise. The results of the experimental investigations clearly show that the flow noise received at the stagnation point is a strong function of free stream velocity, a moderately strong function of body scale but a weak function of boundary layer thickness. In addition, there is evidence that when body scale change is involved, flow noise amplitude scales but no frequency shift is involved. A scaling procedure is proposed based on the present observations along with those of Lauchle. At a given frequency, the amplitude of noise level obtained under model testing conditions is first scaled to account for differences in the velocity and size corresponding to the prototype conditions; then a correction to this is applied to account for losses due to diffraction, which are estimated on the basis of the geometric theory of diffraction (GTD) with the source being located at the predicted position of turbulent transition. Use of the proposed scaling law to extrapolate presently obtained noise levels to two other conditions involving larger-scale bodies show good agreement with actually measured levels, in particular at higher frequencies. Since model scale results have been used successfully to predict levels on larger-sized bodies tested in a totally different environment, the present data along with the proposed scaling procedure can be used to predict the expected flow noise levels at prototype scales during preliminary design studies.

Critical Points and Traveling Wave in Locomotion: Experimental Evidence and Some Theoretical Considerations.

PubMed

Saltiel, Philippe; d'Avella, Andrea; Tresch, Matthew C; Wyler, Kuno; Bizzi, Emilio

2017-01-01

The central pattern generator (CPG) architecture for rhythm generation remains partly elusive. We compare cat and frog locomotion results, where the component unrelated to pattern formation appears as a temporal grid, and traveling wave respectively. Frog spinal cord microstimulation with N-methyl-D-Aspartate (NMDA), a CPG activator, produced a limited set of force directions, sometimes tonic, but more often alternating between directions similar to the tonic forces. The tonic forces were topographically organized, and sites evoking rhythms with different force subsets were located close to the constituent tonic force regions. Thus CPGs consist of topographically organized modules. Modularity was also identified as a limited set of muscle synergies whose combinations reconstructed the EMGs. The cat CPG was investigated using proprioceptive inputs during fictive locomotion. Critical points identified both as abrupt transitions in the effect of phasic perturbations, and burst shape transitions, had biomechanical correlates in intact locomotion. During tonic proprioceptive perturbations, discrete shifts between these critical points explained the burst durations changes, and amplitude changes occurred at one of these points. Besides confirming CPG modularity, these results suggest a fixed temporal grid of anchoring points, to shift modules onsets and offsets. Frog locomotion, reconstructed with the NMDA synergies, showed a partially overlapping synergy activation sequence. Using the early synergy output evoked by NMDA at different spinal sites, revealed a rostrocaudal topographic organization, where each synergy is preferentially evoked from a few, albeit overlapping, cord regions. Comparing the locomotor synergy sequence with this topography suggests that a rostrocaudal traveling wave would activate the synergies in the proper sequence for locomotion. This output was reproduced in a two-layer model using this topography and a traveling wave. Together our results suggest two CPG components: modules, i.e., synergies; and temporal patterning, seen as a temporal grid in the cat, and a traveling wave in the frog. Animal and limb navigation have similarities. Research relating grid cells to the theta rhythm and on segmentation during navigation may relate to our temporal grid and traveling wave results. Winfree's mathematical work, combining critical phases and a traveling wave, also appears important. We conclude suggesting tracing, and imaging experiments to investigate our CPG model.

A case report of motor neuron disease in a patient showing significant level of DDTs, HCHs and organophosphate metabolites in hair as well as levels of hexane and toluene in blood

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kanavouras, Konstantinos; Tzatzarakis, Manolis N.; Mastorodemos, Vasileios

Motor neuron disease is a devastating neurodegenerative condition, with the majority of sporadic, non-familial cases being of unknown etiology. Several epidemiological studies have suggested that occupational exposure to chemicals may be associated with disease pathogenesis. We report the case of a patient developing progressive motor neuron disease, who was chronically exposed to pesticides and organic solvents. The patient presented with leg spasticity and developed gradually clinical signs suggestive of amyotrophic lateral sclerosis, which was supported by the neurophysiologic and radiological findings. Our report is an evidence based case of combined exposure to organochlorine (DDTs), organophosphate pesticides (OPs) and organic solventsmore » as confirmed by laboratory analysis in samples of blood and hair confirming systematic exposure. The concentration of non-specific dialkylphosphates metabolites (DAPs) of OPs in hair (dimethyphopshate (DMP) 1289.4 pg/mg and diethylphosphate (DEP) 709.4 pg/mg) and of DDTs (opDDE 484.0 pg/mg, ppDDE 526.6 pg/mg, opDDD 448.4 pg/mg, ppDDD + opDDT 259.9 pg/mg and ppDDT 573.7 pg/mg) were considerably significant. Toluene and n-hexane were also detected in blood on admission at hospital and quantified (1.23 and 0.87 {mu}g/l, respectively), while 3 months after hospitalization blood testing was found negative for toluene and n-hexane and hair analysis was provided decrease levels of HCHs, DDTs and DAPs. -- Highlights: Black-Right-Pointing-Pointer Exposure to pesticides and organic solvents might be a risk factor for sporadic MND. Black-Right-Pointing-Pointer We report a patient who developed progressive upper and lower motor neuron disease. Black-Right-Pointing-Pointer The patient had a history of occupational exposure to pesticides and solvents. Black-Right-Pointing-Pointer High DDTs' levels and increased levels of DMP and DEP were measured in his hair. Black-Right-Pointing-Pointer The patients' exposure to chemicals might have played a role in MND development.« less

Foetal Alcohol Spectrum Disorders: A consideration of sentencing and unreliable confessions.

PubMed

Douglas, Heather

2015-12-01

While Foetal Alcohol Spectrum Disorders (FASDs) are now a strong focus of policy-makers throughout Australia, they have received strikingly little consideration in Australian criminal courts. Many people who have an FASD are highly suggestible, have difficulty linking their actions to consequences, controlling impulses and remembering things, and thus FASD raises particular issues for appropriate sentencing and the admissibility of evidence. This article considers the approach of Australian criminal courts to FASD. It reviews the recent case of AH v Western Australia which exemplifies the difficulties associated with appropriate sentencing in cases where the accused is likely to have an FASD. The article also considers the implications for Australian courts of the New Zealand case of Pora v The Queen, recently heard by the Privy Council. In this case, the Privy Council accepted expert evidence that people with FASD may confabulate evidence, potentially making their testimony unreliable. The article concludes with an overview of developments in criminal policy and legal response in relation to FASD in the United States, Canada and Australia.

The AMCP Format for Formulary Submissions: Welcome to Version 4.0.

PubMed

2016-05-01

Managed care pharmacists are increasingly presented with complex considerations related to prescription drug formulary management. As prescription drug spending soars, and new effective, but expensive drugs rush to the market, pharmacists and other health care decision makers must evaluate a myriad of important clinical and economic considerations in determining the relative value and, subsequently, the appropriate placement of a product within a formulary. The AMCP Format for Formulary Submissions, Version 4.0, is the next iteration of the Format, which was first released in 2000. Version 4.0, developed by pharmacists from health plan, manufacturer, and academic perspectives, provides updated recommendations on acquiring and evaluating clinical and economic evidence to inform formulary and medical policy decisions. It also includes new guidance related to emerging special topic considerations such as biosimilars, specialty pharmacy products, and companion diagnostic tests. Version 4.0 has been modified to improve the usability of the Format, with clarifying guidance related to logistical considerations such as a recommended time frame for implementation of Version 4.0, as well as dossier updates and ongoing communication between manufacturers and health care decision makers. The Format should be used as a framework for ongoing evidence-based dialogue between manufacturers and payers. The evolving health care landscape will require new levels of collaboration and communication among key stakeholders to successfully navigate the challenges of this new environment. The Format provides a framework to support these critical interactions related to product value by facilitating an evidence-based, transparent approach. This document was prepared by Jeff Lee, PharmD, FCCP, on behalf of the AMCP Format Executive Committee. Committee members reviewed and provided feedback on the final draft. No conflicts of interest, financial or otherwise, were reported.

Evidence-Based Medicine in Facial Trauma.

PubMed

Dougherty, William M; Christophel, John Jared; Park, Stephen S

2017-11-01

This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors. Copyright © 2017 Elsevier Inc. All rights reserved.

Evidence, illness, and causation: an epidemiological perspective on the Russo-Williamson Thesis.

PubMed

Fiorentino, Alexander R; Dammann, Olaf

2015-12-01

According to the Russo-Williamson Thesis, causal claims in the health sciences need to be supported by both difference-making and mechanistic evidence. In this article, we attempt to determine whether Evidence-based Medicine (EBM) can be improved through the consideration of mechanistic evidence. We discuss the practical composition and function of each RWT evidence type and propose that exposure-outcome evidence (previously known as difference-making evidence) provides associations that can be explained through a hypothesis of causation, while mechanistic evidence provides finer-grained associations and knowledge of entities that ultimately explains a causal hypothesis. We suggest that mechanistic evidence holds untapped potential to add value to the assessment of evidence quality in EBM and propose initial recommendations for the integration of mechanistic and exposure-outcome evidence to improve EBM by robustly leveraging available evidence in support of good medical decisions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Chinese herbal medicine for menopausal symptoms

PubMed Central

Zhu, Xiaoshu; Liew, Yuklan; Liu, Zhao Lan

2016-01-01

Background Chinese herbal medicine (CHM) usage is expected to increase as women suffering from menopausal symptoms are seeking alternative therapy due to concerns from the adverse effects (AEs) associated with hormone therapy (HT). Scientific evidence for their effectiveness and safety is needed. Objectives To evaluate the effectiveness and safety of CHM in the treatment of menopausal symptoms. Search methods We searched the Gynaecology and Fertility Group’s Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), MEDLINE, Embase, CINAHL, AMED, and PsycINFO (from inception to March 2015). Others included Current Control Trials, Citation Indexes, conference abstracts in the ISI Web of Knowledge, LILACS database, PubMed, OpenSIGLE database, and China National Knowledge Infrastructure database (CNKI, 1999 to 2015). Other resources included reference lists of articles as well as direct contact with authors. Selection criteria Randomised controlled trials (RCTs) comparing the effectiveness of CHM with placebo, HT, pharmaceutical drugs, acupuncture, or another CHM formula in women over 18 years of age, and suffering from menopausal symptoms. Data collection and analysis Two review authors independently assessed 864 studies for eligibility. Data extractions were performed by them with disagreements resolved through group discussion and clarification of data or direct contact with the study authors. Data analyses were performed in accordance with Cochrane Collaboration guidelines. Main results We included 22 RCTs (2902 women). Participants were from different ethnic backgrounds with the majority of Chinese origin. When CHM was compared with placebo (eight RCTs), there was little or no evidence of a difference between the groups for the following pooled outcomes: hot flushes per day (MD 0.00, 95% CI −0.88 to 0.89; 2 trials, 199 women; moderate quality evidence); hot flushes per day assessed by an overall hot flush score in which a difference of one point equates to one mild hot flush per day (MD −0.81 points, 95% CI −2.08 to 0.45; 3 RCTs, 263 women; low quality evidence); and overall vasomotor symptoms per month measured by the Menopause-Specific Quality of Life questionnaire (MENQOL, scale 0 to 6) (MD −0.42 points; 95% CI −1.52 to 0.68; 3 RCTs, 256 women; low quality evidence). In addition, results from individual studies suggested there was no evidence of a difference between the groups for daily hot flushes assessed by severity (MD −0.70 points, 95% CI −1.00, −0.40; 1 RCT, 108 women; moderate quality evidence); or overall monthly hot flushes scores (MD −2.80 points, 95% CI −8.93 to 3.33; 1 RCT, 84 women; very low quality evidence); or overall daily night sweats scores (MD 0.07 points, 95% CI −0.19 to 0.33, 1 RCT, 64 women; low quality evidence); or overall monthly night sweats scores (MD 1.30 points, 95% CI −1.76 to 4.36, 1 RCT, 84 women; very low quality evidence). However one study using the Kupperman Index reported that overall monthly vasomotor symptom scores were lower in the CHM group (MD −4.79 points, 95% CI −5.52 to −4.06; 1 RCT, 69 women; low quality evidence). When CHM was compared with hormone therapy (HT) (10 RCTs), only two RCTs reported monthly vasomotor symptoms using MENQOL. It was uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI −0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence). Adverse effects were not fully reported in the included studies. Adverse events reported by women taking CHM included mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects were inconclusive because of imprecise estimates of effects: CHM versus placebo (RR 1.51; 95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR 0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus specific conventional medications (such as Fluoxetine and Estazolam) (RR 0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%). Authors’ conclusions We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. The quality of the evidence ranged from very low to moderate; there is a need for well-designed randomised controlled studies. PMID:26976671

Application of point-to-point matching algorithms for background correction in on-line liquid chromatography-Fourier transform infrared spectrometry (LC-FTIR).

PubMed

Kuligowski, J; Quintás, G; Garrigues, S; de la Guardia, M

2010-03-15

A new background correction method for the on-line coupling of gradient liquid chromatography and Fourier transform infrared spectrometry has been developed. It is based on the use of a point-to-point matching algorithm that compares the absorption spectra of the sample data set with those of a previously recorded reference data set in order to select an appropriate reference spectrum. The spectral range used for the point-to-point comparison is selected with minimal user-interaction, thus facilitating considerably the application of the whole method. The background correction method has been successfully tested on a chromatographic separation of four nitrophenols running acetonitrile (0.08%, v/v TFA):water (0.08%, v/v TFA) gradients with compositions ranging from 35 to 85% (v/v) acetonitrile, giving accurate results for both, baseline resolved and overlapped peaks. Copyright (c) 2009 Elsevier B.V. All rights reserved.

Malignant central nervous system tumors among adolescents and young adults (15-39 years old) in 14 Southern-Eastern European registries and the US Surveillance, Epidemiology, and End Results program: Mortality and survival patterns.

PubMed

Georgakis, Marios K; Papathoma, Paraskevi; Ryzhov, Anton; Zivkovic-Perisic, Snezana; Eser, Sultan; Taraszkiewicz, Łukasz; Sekerija, Mario; Žagar, Tina; Antunes, Luis; Zborovskaya, Anna; Bastos, Joana; Florea, Margareta; Coza, Daniela; Demetriou, Anna; Agius, Domenic; Strahinja, Rajko M; Themistocleous, Marios; Tolia, Maria; Tzanis, Spyridon; Alexiou, George A; Papanikolaou, Panagiotis G; Nomikos, Panagiotis; Kantzanou, Maria; Dessypris, Nick; Pourtsidis, Apostolos; Petridou, Eleni T

2017-11-15

Unique features and worse outcomes have been reported for cancers among adolescents and young adults (AYAs; 15-39 years old). The aim of this study was to explore the mortality and survival patterns of malignant central nervous system (CNS) tumors among AYAs in Southern-Eastern Europe (SEE) in comparison with the US Surveillance, Epidemiology, and End Results (SEER) program. Malignant CNS tumors diagnosed in AYAs during the period spanning 1990-2014 were retrieved from 14 population-based cancer registries in the SEE region (n = 11,438). Age-adjusted mortality rates were calculated and survival patterns were evaluated via Kaplan-Meier curves and Cox regression analyses, and they were compared with respective 1990-2012 figures from SEER (n = 13,573). Mortality rates in SEE (range, 11.9-18.5 deaths per million) were higher overall than the SEER rate (9.4 deaths per million), with decreasing trends in both regions. Survival rates increased during a comparable period (2001-2009) in SEE and SEER. The 5-year survival rate was considerably lower in the SEE registries (46%) versus SEER (67%), mainly because of the extremely low rates in Ukraine; this finding was consistent across age groups and diagnostic subtypes. The highest 5-year survival rates were recorded for ependymomas (76% in SEE and 92% in SEER), and the worst were recorded for glioblastomas and anaplastic astrocytomas (28% in SEE and 37% in SEER). Advancing age, male sex, and rural residency at diagnosis adversely affected outcomes in both regions. Despite definite survival gains over the last years, the considerable outcome disparities between the less affluent SEE region and the United States for AYAs with malignant CNS tumors point to health care delivery inequalities. No considerable prognostic deficits for CNS tumors are evident for AYAs versus children. Cancer 2017;123:4458-71. © 2017 American Cancer Society. © 2017 American Cancer Society.

The Thermal Phase Curve Offset on Tidally and Nontidally Locked Exoplanets: A Shallow Water Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Penn, James; Vallis, Geoffrey K, E-mail: jp492@exeter.ac.uk, E-mail: g.vallis@exeter.ac.uk

2017-06-20

Using a shallow water model with time-dependent forcing, we show that the peak of an exoplanet thermal phase curve is, in general, offset from the secondary eclipse when the planet is rotating. That is, the planetary hot spot is offset from the point of maximal heating (the substellar point) and may lead or lag the forcing; the extent and sign of the offset are functions of both the rotation rate and orbital period of the planet. We also find that the system reaches a steady state in the reference frame of the moving forcing. The model is an extension ofmore » the well-studied Matsuno–Gill model into a full spherical geometry and with a planetary-scale translating forcing representing the insolation received on an exoplanet from a host star. The speed of the gravity waves in the model is shown to be a key metric in evaluating the phase curve offset. If the velocity of the substellar point (relative to the planet’s surface) exceeds that of the gravity waves, then the hot spot will lag the substellar point, as might be expected by consideration of forced gravity wave dynamics. However, when the substellar point is moving slower than the internal wave speed of the system, the hottest point may lead the passage of the forcing. We provide an interpretation of this result by consideration of the Rossby and Kelvin wave dynamics, as well as, in the very slowly rotating case, a one-dimensional model that yields an analytic solution. Finally, we consider the inverse problem of constraining planetary rotation rate from an observed phase curve.« less

[Key points for the management of dermatitis in Latin America. The SLAAI Consensus].

PubMed

Sánchez, Jorge; Páez, Bruno; Macías-Weinmann, Alejandra; De Falco, Alicia

2015-01-01

The incidence of atopic dermatitis in Latin America, as in other regions, has been increasing in recent years. The SLAAI consensus is based on a systematic search for articles related to dermatitis, with focus in the pathophysiology and treatment and its impact on Latin America, and reviewed using the Delphi methodology (Revista Alergia Mexico 2014;61:178-211). In this article we highlight the key points of consensus and particular considerations in Latin America.

Probabilistic Surface Characterization for Safe Landing Hazard Detection and Avoidance (HDA)

NASA Technical Reports Server (NTRS)

Johnson, Andrew E. (Inventor); Ivanov, Tonislav I. (Inventor); Huertas, Andres (Inventor)

2015-01-01

Apparatuses, systems, computer programs and methods for performing hazard detection and avoidance for landing vehicles are provided. Hazard assessment takes into consideration the geometry of the lander. Safety probabilities are computed for a plurality of pixels in a digital elevation map. The safety probabilities are combined for pixels associated with one or more aim points and orientations. A worst case probability value is assigned to each of the one or more aim points and orientations.

Adapting Evidence-Based Practices to Meet the Needs of English Learners with Mathematics Difficulties

ERIC Educational Resources Information Center

Doabler, Christian T.; Nelson, Nancy J.; Clarke, Ben

2016-01-01

Convincing evidence suggests that a considerable number of U.S. students struggle to develop mathematics proficiency. One subgroup of students who have a high probability of mathematical failure is English learners (ELs), who now represent 10% of the U.S. student population; 70% of these students speak Spanish at home (Fry & Passel, 2009). ELs…

The Impact of Research on Education Policy in an Era of Evidence-Based Policy

ERIC Educational Resources Information Center

Lingard, Bob

2013-01-01

Currently, when there is a lot of political talk about the need for "evidence-based policy", and when public policy seeks to calibrate research quality and impact, there is a pressing need to reconsider the relationships between education/al research and education policy. This article seeks to do this, beginning with considerations of the…

Linking Metatraits of the Big Five to Well-Being and Ill-Being: Do Basic Psychological Needs Matter?

ERIC Educational Resources Information Center

Simsek, Omer Faruk; Koydemir, Selda

2013-01-01

There is considerable evidence that two higher order factors underlie the Big-Five dimensions and that these two factors provide a parsimonious taxonomy. However, not much empirical evidence has been documented as to the extent to which these traits relate to certain psychological constructs. In this study, we tested a structural model to…

Researching the psychological therapies in prison: considerations and future recommendations.

PubMed

Gee, Joanna; Bertrand-Godfrey, Betty

2014-01-01

The psychological therapies are widely considered within the forensic literature as holding a useful role in the prison system, however, despite this, very little research into the psychological therapies has taken place. Further, where research is carried out, it is often associated with the need for evidence-based practice (EBP), involving quantification and randomization. The paper aims to discuss these issues. This paper will initially introduce the importance of research into the psychological therapies in prison, followed by a consideration of EBP which can be thought of as the current movement governing research in the psychological therapies in the UK. However, in providing a focused critique of EBP, particularly within prisons, this paper will attempt to pave the way for a consideration of alternative research methodologies and resultant methods in researching the psychological therapies in prisons in the UK. Through this it is argued that research within the prison setting should act not to promote interventions and create an evidence-based as such, but to provide an accessible body of knowledge for the psychological therapists working in prisons in the UK.

THE ENVIRONMENT AND SUSCEPTIBILITY TO SCHIZOPHRENIA

PubMed Central

Brown, Alan S.

2010-01-01

In the present article the putative role of environmental factors in schizophrenia is reviewed and synthesized. Accumulating evidence from recent studies suggests that environmental exposures may play a more significant role in the etiopathogenesis of this disorder than previously thought. This expanding knowledge base is largely a consequence of refinements in the methodology of epidemiologic studies, including birth cohort investigations, and in preclinical research that has been inspired by the evolving literature on animal models of environmental exposures. The bulk of evidence supports a contribution of environmental factors acting during fetal and perinatal life; these include infections, nutritional deficiencies, paternal age, fetal/neonatal hypoxic insults, maternal stress and other exposures. A considerable amount of data supports cannabis use in adolescence, migration, unfavorable neighborhood environments, and possibly infections at different points in the lifespan as risk factors for schizophrenia. Animal models have yielded evidence suggesting that these exposures cause brain and behavioral phenotypes that are analogous to findings observed in patients with schizophrenia. It is suggested that future studies attempt to replicate these findings, identify new risk factors, explore the gestational specificity of environmental insults, elaborate developmental trajectories, and examine relationships between environmental exposures and structural and functional brain anomalies in schizophrenia patients. Future research on gene-environment interactions and epigenetic effects of environmental exposures should shed further light on genes and exposures that may not be identified in the absence of these integrated approaches. Moreover, translational studies should further facilitate the discovery of neurodevelopmental mechanisms that increase susceptibility to schizophrenia. The study of environmental factors in schizophrenia may have important implications for the prevention of this disorder, and offers the potential to complement, and refine, existing efforts on explanatory neurodevelopmental models. PMID:955757

Immunogenicity of HPV prophylactic vaccines: Serology assays and their use in HPV vaccine evaluation and development.

PubMed

Pinto, Ligia A; Dillner, Joakim; Beddows, Simon; Unger, Elizabeth R

2018-01-17

When administered as standard three-dose schedules, the licensed HPV prophylactic vaccines have demonstrated extraordinary immunogenicity and efficacy. We summarize the immunogenicity of these licensed vaccines and the most commonly used serology assays, with a focus on key considerations for one-dose vaccine schedules. Although immune correlates of protection against infection are not entirely clear, both preclinical and clinical evidence point to neutralizing antibodies as the principal mechanism of protection. Thus, immunogenicity assessments in vaccine trials have focused on measurements of antibody responses to the vaccine. Non-inferiority of antibody responses after two doses of HPV vaccines separated by 6 months has been demonstrated and this evidence supported the recent WHO recommendations for two-dose vaccination schedules in both boys and girls 9-14 years of age. There is also some evidence suggesting that one dose of HPV vaccines may provide protection similar to the currently recommended two-dose regimens but robust data on efficacy and immunogenicity of one-dose vaccine schedules are lacking. In addition, immunogenicity has been assessed and reported using different methods, precluding direct comparison of results between different studies and vaccines. New head-to-head vaccine trials evaluating one-dose immunogenicity and efficacy have been initiated and an increase in the number of trials relying on immunobridging is anticipated. Therefore, standardized measurement and reporting of immunogenicity for the up to nine HPV types targeted by the current vaccines is now critical. Building on previous HPV serology assay standardization and harmonization efforts initiated by the WHO HPV LabNet in 2006, new secondary standards, critical reference reagents and testing guidelines will be generated as part of a new partnership to facilitate harmonization of the immunogenicity testing in new HPV vaccine trials. Copyright © 2018 Elsevier Ltd. All rights reserved.

Gone to Pot – A Review of the Association between Cannabis and Psychosis

PubMed Central

Radhakrishnan, Rajiv; Wilkinson, Samuel T.; D’Souza, Deepak Cyril

2014-01-01

Cannabis is the most commonly used illicit drug worldwide, with ~5 million daily users worldwide. Emerging evidence supports a number of associations between cannabis and psychosis/psychotic disorders, including schizophrenia. These associations-based on case-studies, surveys, epidemiological studies, and experimental studies indicate that cannabinoids can produce acute, transient effects; acute, persistent effects; and delayed, persistent effects that recapitulate the psychopathology and psychophysiology seen in schizophrenia. Acute exposure to both cannabis and synthetic cannabinoids (Spice/K2) can produce a full range of transient psychotomimetic symptoms, cognitive deficits, and psychophysiological abnormalities that bear a striking resemblance to symptoms of schizophrenia. In individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. Several factors appear to moderate these associations, including family history, genetic factors, history of childhood abuse, and the age at onset of cannabis use. Exposure to cannabinoids in adolescence confers a higher risk for psychosis outcomes in later life and the risk is dose-related. Individuals with polymorphisms of COMT and AKT1 genes may be at increased risk for psychotic disorders in association with cannabinoids, as are individuals with a family history of psychotic disorders or a history of childhood trauma. The relationship between cannabis and schizophrenia fulfills many but not all of the standard criteria for causality, including temporality, biological gradient, biological plausibility, experimental evidence, consistency, and coherence. At the present time, the evidence indicates that cannabis may be a component cause in the emergence of psychosis, and this warrants serious consideration from the point of view of public health policy. PMID:24904437

Environmental mixtures of nanomaterials and chemicals: The Trojan-horse phenomenon and its relevance for ecotoxicity.

PubMed

Naasz, Steffi; Altenburger, Rolf; Kühnel, Dana

2018-04-22

The usage of engineered nanomaterials (NM) offers many novel products and applications with advanced features, but at the same time raises concerns with regard to potential adverse biological effects. Upon release and emission, NM may interact with chemicals in the environment, potentially leading to a co-exposure of organisms and the occurrence of mixture effects. A prominent idea is that NM may act as carriers of chemicals, facilitating and enhancing the entry of substances into cells or organisms, subsequently leading to an increased toxicity. In the literature, the term 'Trojan-horse effect' describes this hypothesis. The relevance of this mechanism for organisms is, however, unclear as yet. Here, a review has been performed to provide a more systematic picture on existing evidence. It includes 151 experimental studies investigating the exposure of various NM and chemical mixtures in ecotoxicological in vitro and in vivo model systems. The papers retrieved comprised studies investigating (i) uptake, (ii) toxicity and (iii) investigations considering both, changes in substance uptake and toxicity upon joint exposure of a chemical with an NM. A closer inspection of the studies demonstrated that the existing evidence for interference of NM-chemical mixture exposure with uptake and toxicity points into different directions compared to the original Trojan-horse hypothesis. We could discriminate at least 7 different categories to capture the evidence ranging from no changes in uptake and toxicity to an increase in uptake and toxicity upon mixture exposure. Concluding recommendations for the consideration of relevant processes are given, including a proposal for a nomenclature to describe NM-chemical mixture interactions in consistent terms. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Targeting Type 2 Diabetes with C-Glucosyl Dihydrochalcones as Selective Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors: Synthesis and Biological Evaluation.

PubMed

Jesus, Ana R; Vila-Viçosa, Diogo; Machuqueiro, Miguel; Marques, Ana P; Dore, Timothy M; Rauter, Amélia P

2017-01-26

Inhibiting glucose reabsorption by sodium glucose co-transporter proteins (SGLTs) in the kidneys is a relatively new strategy for treating type 2 diabetes. Selective inhibition of SGLT2 over SGLT1 is critical for minimizing adverse side effects associated with SGLT1 inhibition. A library of C-glucosyl dihydrochalcones and their dihydrochalcone and chalcone precursors was synthesized and tested as SGLT1/SGLT2 inhibitors using a cell-based fluorescence assay of glucose uptake. The most potent inhibitors of SGLT2 (IC 50 = 9-23 nM) were considerably weaker inhibitors of SGLT1 (IC 50 = 10-19 μM). They showed no effect on the sodium independent GLUT family of glucose transporters, and the most potent ones were not acutely toxic to cultured cells. The interaction of a C-glucosyl dihydrochalcone with a POPC membrane was modeled computationally, providing evidence that it is not a pan-assay interference compound. These results point toward the discovery of structures that are potent and highly selective inhibitors of SGLT2.